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).
After an ankle fracture in a car accident in New South Wales, injured road users must act quickly to protect their legal rights under the Compulsory Third Party (CTP) scheme. The first steps include seeking medical attention, documenting the accident, and contacting the relevant insurer through the State Insurance Regulatory Authority (SIRA). Ankle fractures, like other lower limb injuries, fall under the Motor Accident Injuries Act 2017, which governs statutory benefits and compensation eligibility. This article explains the practical actions to take, the evidence required, and how SIRA's claims process applies to ankle fractures.
Key Legal Framework for CTP Claims
New South Wales' CTP scheme provides compensation for injuries caused by motor vehicle accidents, regardless of fault. Under the Motor Accident Injuries Act 2017, injured road users are entitled to treatment and care benefits, weekly income payments, and lump sum damages if their injury meets the 'threshold injury' criteria. Ankle fractures are classified as threshold injuries if they meet the spinal nerve-root qualification outlined in the Motor Accident Guidelines. This means injuries causing neurological signs, even without radiculopathy, may qualify for statutory benefits.
Immediate Actions After an Ankle Fracture
- Seek Medical Attention Immediately: A doctor must confirm the injury and document its severity. Medical records are critical evidence for claims, as they establish the injury's nature and link it to the accident. Delaying treatment may affect eligibility for benefits.
- Document the Accident Scene: Take photographs of the injury, vehicle damage, and the surrounding area. Note the time, location, and conditions of the accident. Witness details and traffic camera footage may also be relevant.
- Notify the Insurer via SIRA: Contact the at-fault driver's insurer through SIRA's claims process. SIRA handles claims under the CTP scheme, ensuring injured parties receive statutory benefits like treatment coverage and income support.
- Preserve Evidence of Income Loss: Keep records of lost wages, medical expenses, and any impact on daily activities. These documents support claims for weekly income payments and future loss of earnings.
Documentation Needed for Ankle Fracture Claims
SIRA requires specific evidence to process claims involving ankle fractures. Key documents include:
- Medical Reports: Confirming the injury's classification as a threshold injury.
- Accident Reports: From police or the driver's insurer.
- Witness Statements: To corroborate the incident.
- Photographs: Of the injury and accident scene.
- Medical Bills: To claim treatment and care benefits.
If your ankle fracture results in long-term mobility issues, you may also need specialist assessments to support a claim for lump sum damages under the CTP scheme.
Time Limits and Dispute Resolution
CTP claims must be submitted within 52 weeks of the accident if the injury is classified as a threshold injury. After this period, weekly benefits and treatment coverage typically stop unless the injury is later found to be more severe. If your claim is disputed, SIRA provides a review process, and legal advice may be necessary to challenge decisions.
When to Seek Legal Advice
While SIRA handles most claims, legal assistance is recommended if:
- The injury exceeds the threshold injury definition.
- There are disputes over fault or compensation.
- The claim involves complex circumstances like multiple accidents or overlapping workers' compensation issues.
Example Scenario
A pedestrian struck by a car sustains an ankle fracture. A doctor documents the injury as a threshold injury, and the pedestrian submits a claim through SIRA. After 52 weeks, the pedestrian's weekly benefits stop, but they later seek legal advice to argue that the fracture caused long-term mobility issues, qualifying for additional damages.
Next Steps
CTP entitlements depend on the accident date, injury severity, and claim history. To request contact about your circumstances, complete the quick, no obligation enquiry form.