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 New South Wales are handled under the Compulsory Third Party (CTP) scheme, which provides compensation through the State Insurance Regulatory Authority (SIRA). If you've suffered an ankle fracture in a motor vehicle crash, understanding how SIRA assesses claims and what evidence is needed is critical. This article explains the legal framework, practical steps, and time limits relevant to ankle fracture claims in NSW.
How SIRA Handles Ankle Fracture Claims
SIRA evaluates claims based on the severity of the injury and its impact on daily life. Ankle fractures are classified under 'threshold injuries' if they meet specific criteria outlined in the Motor Accident Guidelines. For example, a fracture requiring surgical repair or causing significant mobility issues would qualify for benefits. SIRA uses medical reports to determine whether the injury meets the threshold, which affects eligibility for weekly payments and treatment benefits.
Types of Compensation Available
Under the Motor Accident Injuries Act 2017, injured people may receive:
- Weekly income payments for lost wages if the fracture prevents work for 52 weeks or more.
- Treatment and care benefits to cover medical expenses, physiotherapy, and equipment.
- Lump sum payments if the injury results in long-term impairment, such as chronic pain or reduced mobility.
If the ankle fracture is classified as a 'threshold injury, ' benefits are generally limited to 52 weeks unless the injury meets the whole person impairment threshold (WPI), which requires a specialist assessment.
Evidence Required for Ankle Fracture Claims
To support a claim, you must provide:
- A medical report confirming the fracture and its impact on mobility.
- Accident details including police reports, witness statements, and photos of the scene.
- Income records to establish lost wages for weekly payments.
- Medical bills and receipts for treatment and care.
SIRA may request additional documentation, such as a doctor’s opinion on recovery time or the need for ongoing support.
Time Limits and Dispute Options
You must notify SIRA of your claim within 6 months of the accident date. If you fail to meet this deadline, you may lose your right to benefits. Disputes over claim outcomes can be escalated to the NSW Civil and Administrative Tribunal (NCAT) for review. However, time limits for disputes depend on the specific issue and must be addressed promptly.
When to Seek Legal Advice
While SIRA handles most claims, complex cases, such as those involving multiple injuries, disputes over fault, or long-term impairment, may require legal assistance. A solicitor can help challenge SIRA decisions, negotiate better outcomes, or pursue a common law damages claim if the injury exceeds threshold criteria.
Example Scenario
Consider a driver who fractured their ankle in a collision. They submit a medical report showing the fracture required surgery and caused prolonged mobility issues. SIRA assesses the injury as a threshold claim, awarding 26 weeks of weekly payments and treatment benefits. After 52 weeks, the claim ends unless the injury meets the WPI threshold, which would require a specialist’s opinion.
Next Steps
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.