Ankle Fractures and CTP Claims in NSW
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 resulting from car accidents in New South Wales are covered under the Compulsory Third Party (CTP) scheme. If you've suffered an ankle fracture in a motor vehicle crash, preserving specific evidence is critical to support your claim. The New South Wales Motor Accident Injuries Act 2017 and SIRA guidelines outline what records are required to establish entitlements to treatment, income support, and other benefits. This article explains the evidence you must keep, how SIRA evaluates ankle fracture claims, and the legal boundaries of CTP compensation.
Key Evidence for Ankle Fracture Claims
To support a CTP claim for an ankle fracture, you must document:
- Medical records showing the injury, including X-rays, MRI scans, and reports from a medical practitioner. SIRA requires evidence of a spinal nerve-root injury or radiculopathy to qualify as a threshold injury.
- Accident details such as police reports, witness statements, and photographs of the scene. These help establish the incident's circumstances.
- Medical treatment records including dates of visits, prescribed therapies, and recovery timelines. SIRA assesses whether the injury meets the 'threshold injury' definition under the Motor Accident Guidelines.
- Income and employment records to support claims for weekly income benefits. This includes payslips, employment contracts, and evidence of lost wages.
- Statements from medical professionals confirming the injury's impact on mobility, work capacity, or daily activities.
How SIRA Evaluates Ankle Fractures
SIRA evaluates ankle fractures under the Motor Accident Injuries Act 2017. Ankle fractures are considered threshold injuries if they meet specific criteria, such as:
- A spinal nerve-root injury producing neurological signs (e.g., weakness, numbness) other than radiculopathy.
- Radiculopathy requiring specified clinical signs under the Motor Accident Guidelines.
If your ankle fracture is classified as a threshold injury, you may be eligible for:
- Weekly income benefits for 52 weeks, provided the injury is your only consequence.
- Treatment and care benefits covering medical expenses, physiotherapy, and other recovery costs.
- Rehabilitation support to restore mobility and function.
However, if the injury exceeds the threshold (e.g., severe ligament damage, chronic instability), you may need to pursue a common law damages claim separately. SIRA does not cover such claims under the CTP scheme.
Time Limits and Dispute Resolution
CTP claims must be submitted within 52 weeks of the accident if the injury is a threshold injury. If the injury is more severe, the time limit may extend, but this depends on the specific circumstances. Delays can jeopardize entitlements to weekly benefits and treatment coverage.
Disputes over ankle fracture claims are resolved by SIRA's independent review process. If your claim is rejected, you may:
- Request a review by SIRA's internal team.
- Appeal to the NSW Civil and Administrative Tribunal (NCAT) within 28 days of the decision.
- Seek legal advice if the dispute involves complex medical or legal issues.
Practical Example: Ankle Fracture Claim in Albury
Consider a scenario where a cyclist in Albury NSW sustains an ankle fracture after a car collision. The injured person:
- Keeps all medical records, including a doctor's note stating the fracture is a threshold injury.
- Submits a police report and witness statement describing the accident.
- Documents lost wages from work and provides a medical certificate confirming inability to work.
SIRA assesses the claim and determines the ankle fracture qualifies as a threshold injury. The injured person receives weekly income benefits and treatment coverage for 52 weeks. If the injury worsens and requires surgery, they may need to pursue additional compensation through a separate legal process.
When to Seek Legal Advice
Consult a solicitor if:
- Your ankle fracture exceeds the threshold injury definition.
- You face a dispute over claim eligibility.
- You need assistance navigating SIRA's review process.
- You want to understand your options for common law damages.
Legal professionals can help you determine whether your injury falls under the CTP scheme or requires a separate claim. They can also advise on time limits and dispute resolution options.
Next Steps
CTP claims for ankle fractures depend on the injury's classification, the evidence you preserve, and the timing of your claim. If you're unsure whether your ankle fracture qualifies for benefits, or if you need help documenting your case, complete the quick, no obligation enquiry form. A legal professional can assess your circumstances and guide you through the process.