Where a person's only injuries resulting from the accident are threshold injuries, weekly benefits and treatment and care generally cease after 52 weeks (ss 3.11 and 3.28).
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 motor vehicle accidents are covered under New South Wales' Compulsory Third Party (CTP) insurance scheme. The NSW government's State Insurance Regulatory Authority (SIRA) provides guidelines for assessing claims, including how injuries are evaluated and benefits determined. This article explains how ankle fractures are handled in CTP claims, outlines eligible benefits, and provides practical examples based on SIRA's approach.
How NSW CTP Rules Apply to Ankle Fractures
Under the Motor Accident Injuries Act 2017, ankle fractures are classified as 'threshold injuries' if they meet specific medical criteria. SIRA's guidelines state that injuries must produce neurological signs, such as pain, swelling, or restricted movement, to qualify. For example, a broken ankle that limits walking or causes chronic pain may be considered a threshold injury. However, if the fracture is minor and heals fully within 52 weeks, benefits may be limited under the scheme's 52-week statutory cap.
Practical Steps and Evidence for Ankle Fracture Claims
To support a claim, injured persons must provide medical evidence confirming the injury's severity. Key documents include:
- Medical records detailing the fracture's diagnosis and treatment
- Accident reports from police or insurance companies
- Witness statements or photos of the incident
- Evidence of how the injury affects daily activities (e.g., difficulty walking, reduced mobility)
For instance, a passenger who broke their ankle in a low-speed collision may need to show that the injury required medical treatment and impacted their ability to work or perform household tasks. SIRA assesses claims based on the injury's alignment with the 'threshold injury' definition in the Motor Accident Guidelines.
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. If the injury is more severe and falls outside the threshold category, there is no time limit. Disputes over injury severity may arise, requiring medical experts to review the claim. In such cases, injured persons should seek legal advice to challenge an insurer's decision.
When to Seek Legal Advice
Legal assistance is recommended if:
- The injury's severity is disputed by the insurer
- The claimant is unsure whether their injury qualifies for benefits
- There are delays in processing the claim
A solicitor can help navigate SIRA's assessment process and ensure all evidence is properly submitted.
Next Steps
CTP entitlements depend on the accident date, injury type, and claim history. To discuss your circumstances, complete the quick, no obligation enquiry form. Every claim depends on its own facts.