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).
Ankle fractures typically qualify for compensation under the NSW Compulsory Third Party (CTP) scheme, but eligibility depends on meeting specific injury thresholds and providing evidence of the injury. This article explains how ankle fractures are assessed under the scheme, what evidence is needed, and how Ballina claimants should proceed.
How Ankle Fractures Qualify Under the CTP Scheme
Under the Motor Accident Injuries Act 2017, injuries must meet the 'threshold injury' criteria to be eligible for benefits. Ankle fractures are generally considered threshold injuries because they involve a break in a bone of the lower limb. However, the injury must be confirmed as a 'threshold injury' by a medical practitioner following the Motor Accident Guidelines. For example, a fractured tibia or fibula would typically qualify, but the injury must be documented with imaging (e.g., X-rays) and a clinical assessment.
Evidence Required for a Claim
To claim compensation for an ankle fracture, you must provide:
- Medical records confirming the fracture (e.g., X-rays, MRI scans, and a doctor’s report)
- Evidence of the accident (e.g., police report, witness statements, or photographs of the scene)
- Proof of income loss if you’re unable to work due to the injury
- A statement from your doctor explaining how the injury affects your daily activities
If the fracture is severe enough to cause long-term mobility issues, you may also need to provide evidence of ongoing treatment or rehabilitation.
Time Limits and Dispute Options
Claims must be made within 52 weeks of the accident if the injury is a threshold injury. After this period, benefits like weekly income payments and treatment and care benefits are generally limited unless the injury results in a permanent impairment. If your claim is disputed, you can request a review by the State Insurance Regulatory Authority (SIRA) or seek independent medical advice to challenge the assessment.
Practical Steps for Ballina Claimants
While Ballina is a specific location, the CTP scheme applies statewide. Ensure you:
- Notify your insurer or the at-fault driver’s insurer within 52 weeks
- Seek medical attention immediately after the accident to document the injury
- Keep all accident-related documents organized and submit them to the insurer
When to Seek Legal Advice
If your claim is denied, or if you’re unsure about your eligibility, consult a solicitor. Legal professionals can help you navigate disputes, challenge incorrect assessments, and ensure you receive all available benefits.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.