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've suffered an ankle fracture from a car accident in Balmain and your CTP claim is disputed, understanding your options under NSW law is critical. SIRA assesses compensation based on medical evidence and statutory guidelines, but disputes can arise over injury severity, claim eligibility, or benefit calculations. This article explains how to challenge a denied claim, what evidence matters, and the formal dispute pathways available under the Motor Accident Injuries Act 2017.
How SIRA Assesses Ankle Fractures in CTP Claims
SIRA evaluates ankle fractures using the Motor Accident Guidelines, which define 'threshold injuries' as those requiring treatment. For fractures, this typically includes X-rays confirming a break, medical records detailing treatment, and evidence of functional limitation. Under the Act, weekly income payments and treatment benefits are available for injuries meeting the threshold, but disputes often arise over whether the fracture qualifies as a 'threshold injury' under the spinal nerve-root qualification.
Dispute Resolution Options for Ankle Fractures
If your claim is denied, you can first request an internal review from SIRA. This involves submitting fresh evidence, such as a second medical opinion or updated imaging. If unresolved, you may escalate to the Personal Injury Commission (PIC), which handles disputes over medical assessments. The PIC can order independent medical reports to determine if the injury meets the threshold for compensation. Note that challenges do not guarantee a changed decision, the PIC will assess whether the original assessment was legally sound.
Practical Steps and Evidence for Ankle Fracture Claims
To support your claim, gather: medical records showing the fracture and treatment, accident reports from NSW Police or the driver's insurance, witness statements, and evidence of income loss. For disputes, focus on proving the fracture meets the 'threshold injury' definition under the Motor Accident Guidelines. For example, if your X-rays show a non-displaced fracture but you have significant swelling and mobility issues, this could support a claim for treatment benefits.
Time Limits and When to Seek Advice
You have 52 weeks from the accident date to claim weekly benefits for threshold injuries. After this period, benefits generally stop unless you can prove the injury is not 'only' a threshold injury. If your claim is denied, act quickly: SIRA has 28 days to respond to a review request, and the PIC has 21 days to issue a decision on medical disputes. Delays can reduce your entitlements or lead to missed deadlines.
Example: Challenging a Denied Ankle Fracture Claim
Consider a scenario where a driver fractures their ankle in a Balmain car accident but is told the injury is not a 'threshold injury' because the X-ray shows a non-displaced break. The claimant could challenge this by providing evidence of prolonged pain, difficulty walking, and a medical opinion confirming the fracture meets the threshold. SIRA might then refer the case to the PIC for a medical review.
Next Steps for Balmain Residents
CTP claims involving ankle fractures can be complex, especially when disputes arise over injury severity or benefit eligibility. While SIRA provides a statutory framework, challenges often require specialist input to navigate the medical and legal requirements. If your claim is denied, seek advice before the 52-week deadline for weekly benefits. Time limits and procedural rules can significantly impact your entitlements.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.