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 from car accidents in NSW may entitle injured people to compensation through the Compulsory Third Party (CTP) scheme. This article explains what injured individuals in Ashfield need to know about claiming treatment costs, income loss, and other support after an ankle fracture. It covers how SIRA assesses claims, what evidence is required, and time limits for seeking compensation.
What Compensation Is Available for Ankle Fractures?
Under NSW CTP laws, ankle fractures fall under the 'threshold injury' category if they meet specific medical criteria. Injured people may claim:
- Medical treatment benefits to cover costs of scans, X-rays, physiotherapy, and specialist care.
- Weekly income payments if the injury prevents work for up to 52 weeks.
- Out-of-pocket expenses like transport to appointments or medication.
- Lost wages if the fracture stops someone from working beyond 52 weeks.
SIRA handles these claims, but the amount depends on the injury's severity and medical evidence. For example, a broken ankle requiring surgery would likely qualify for more support than a minor sprain.
How Does SIRA Assess Medical Costs for Ankle Fractures?
SIRA uses the Motor Accident Guidelines to determine if treatment is 'reasonably necessary.' Medical records must show:
- A confirmed ankle fracture via imaging (e.g., X-ray or MRI).
- A treatment plan from a registered medical practitioner.
- That the treatment is directly related to the accident.
In a hypothetical case, a cyclist with a fractured ankle who undergoes surgery and physiotherapy would receive benefits covering all these costs, provided the treatment is documented as necessary.
What Evidence Matters for a Claim?
To support an ankle fracture claim, injured people should gather:
- Medical records showing the injury and treatment.
- Accident reports from police or the driver's insurance.
- Witness statements or photos of the crash scene.
- Income records to prove lost wages.
- Correspondence with insurers or SIRA.
Evidence must link the ankle fracture directly to the accident. For instance, a doctor's note stating the injury occurred in a car crash is crucial.
Time Limits and Dispute Options
Claims must be submitted within five years of the accident, but delays can reduce benefits. For injuries meeting the 'threshold injury' definition, weekly payments stop after 52 weeks unless the injury is severe enough for a 'whole person impairment' rating.
If SIRA disputes a claim, injured people can:
- Request a review by SIRA's internal team.
- Seek mediation through the NSW Civil and Administrative Tribunal (NCAT).
- Consult a solicitor for formal dispute resolution.
When to Seek Legal Advice?
While many claims are resolved through SIRA, complex cases, such as those involving long-term disability or disputes over treatment costs, may require a lawyer. A solicitor can help navigate:
- Negotiating fair compensation.
- Challenging incorrect decisions.
- Ensuring all evidence is properly submitted.
Next Steps
CTP claims depend on the accident date, injury type, and evidence collected. Injured people in Ashfield should act quickly to preserve their rights. For personalized guidance, complete the quick, no obligation enquiry form to request contact about your circumstances.