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 your ankle fracture from a car accident is disputed under NSW Compulsory Third Party (CTP) laws, understanding your options is critical. This article explains how to resolve disputes under the Motor Accident Injuries Act 2017, referencing SIRA guidelines and practical steps for Auburn residents.
How SIRA Handles Ankle Fracture Disputes
SIRA (State Insurance Regulatory Authority) oversees CTP claims in NSW. For ankle fractures, disputes often arise over whether the injury meets the 'threshold injury' definition under the Motor Accident Guidelines. SIRA assesses claims based on medical evidence, including imaging and clinical notes, to determine if the injury qualifies for benefits. If a claim is disputed, SIRA may request additional documentation or refer the case to a medical expert for review.
Practical Steps for Disputed Ankle Fracture Claims
When a claim is contested, take these steps:
- Gather medical records: Ensure your GP or specialist provides detailed reports linking the fracture to the accident. Radiology reports (X-rays, MRIs) are essential.
- Document the accident: Submit police reports, witness statements, and photographs of the scene to support your case.
- Request a review: If SIRA rejects your claim, you can formally request a reconsideration within 28 days of the decision. This must be done in writing and include new evidence.
- Seek independent medical opinion: If the dispute involves injury severity, consult a specialist to confirm the fracture meets the threshold injury criteria.
Time Limits and When to Seek Advice
You have 52 weeks from the accident date to claim benefits for threshold injuries under the Motor Accident Injuries Act 2017. If your claim is disputed after this period, you may lose access to weekly payments and treatment benefits. However, disputes over injury severity or benefit calculation can still be resolved through SIRA’s internal review process. If your claim involves a dispute over the extent of your injury or the impact on your ability to work, seek legal advice within 6 months of the accident to ensure all options are explored.
Example: Resolving a Disputed Ankle Fracture Claim
Consider a scenario where a driver fractures their ankle in a low-speed collision. SIRA may dispute the claim if the fracture is deemed minor. By submitting a detailed medical report confirming the injury meets the threshold injury definition (e.g., a 10% whole person impairment), the claimant can challenge the decision. SIRA may then refer the case to a medical expert for a second opinion, leading to a revised assessment.
Next Steps
CTP disputes over ankle fractures require careful navigation of SIRA’s processes and medical evidence standards. If your claim is contested, act promptly to preserve your right to benefits. For tailored guidance, complete the quick, no obligation enquiry form to request contact about your circumstances.