Ankle Fractures After 2017 NSW CTP Reforms
A threshold injury under the Motor Accident Injuries Act 2017 (NSW) includes a soft tissue injury and a psychological or psychiatric injury that is not a recognised psychiatric illness (adjustment disorder and acute stress disorder are the usual examples; s 1.6 and Motor Accident Guidelines Part 5).
If you suffered an ankle fracture in a car accident in Greater Sydney, the 2017 reforms to NSW Compulsory Third Party (CTP) laws may affect your claim. Before 2017, injuries were assessed under the Motor Accidents Compensation Act 1999 (MACA), but the new Motor Accident Injuries Act 2017 (MAIA) changed how claims are handled. This article explains the key changes for ankle fractures, how SIRA evaluates claims, and what you need to know to pursue compensation.
Key Changes to CTP Claims for Ankle Fractures
The 2017 reforms introduced a unified CTP scheme under the MAIA, replacing the old MACA system. For ankle fractures, the main changes include:
- Threshold injury definition: Under the MAIA, injuries must meet a specific threshold to qualify for statutory benefits. Ankle fractures are now classified as 'threshold injuries' only if they meet the spinal nerve-root criteria in the Motor Accident Guidelines. This means not all broken ankles automatically qualify for benefits.
- Statutory benefits limitations: If your ankle fracture is a 'threshold injury' and you receive weekly payments for 52 weeks, benefits generally stop unless you have a whole person impairment (WPI) rating of 10% or more. This is a key difference from the pre-2017 system, where some ankle fractures could qualify for longer-term payments.
- SIRA's role: The State Insurance Regulatory Authority (SIRA) now oversees CTP claims under the MAIA. SIRA uses the Motor Accident Guidelines to assess whether your ankle fracture meets the threshold injury definition. This includes evaluating clinical signs like neurological impairment or functional limitation.
What SIRA Considers for Ankle Fracture Claims
SIRA assesses ankle fractures based on the Motor Accident Guidelines, which define 'threshold injury' as:
- A spinal nerve-root injury producing neurological signs other than radiculopathy
- Radiculopathy requiring specific clinical signs (e.g., sensory or motor deficits)
For ankle fractures, SIRA considers:
- Medical evidence confirming the fracture
- Evidence of functional limitation or pain affecting daily activities
- Whether the injury meets the threshold injury definition
If your ankle fracture doesn't meet the threshold injury criteria, you may still be eligible for common law damages if you can prove fault and a genuine injury.
Practical Steps for Ankle Fracture Claims
To support your claim, gather:
- Medical records confirming the ankle fracture and its impact
- Accident reports and witness statements
- Photos of the accident scene
- Income records to establish lost earnings
- Correspondence with insurers
You must notify your insurer within 28 days of the accident. If you're unsure about your claim's validity, seek advice before missing this deadline.
Disputes and When to Seek Help
If your claim is disputed, SIRA may request a medical assessment. You can also apply for a review of the insurer's decision. However, the 2017 reforms introduced stricter rules for disputes, so it's important to act quickly. If your ankle fracture involves complex medical issues or long-term impairment, consulting a solicitor may help ensure your claim is properly assessed.
Example: How a 2017 Claim Differs
Consider two scenarios: a 2016 accident and a 2023 accident. In 2016, an ankle fracture might have qualified for 52 weeks of weekly payments regardless of impairment. Under the 2017 reforms, the same injury would only qualify for benefits if it meets the threshold injury definition. If the fracture doesn't meet the criteria, you may need to pursue a common law damages claim instead.
Next Steps
The 2017 reforms changed how ankle fractures are assessed under NSW CTP laws. To understand how these changes apply to your specific case, complete the quick, no obligation enquiry form. Every claim depends on its own facts, and the available options may depend on the evidence and applicable law.