Ankle Fractures and NSW CTP Claims
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).
If you've suffered an ankle fracture in a car accident in NSW, understanding how insurers assess your claim is critical. Under the Motor Accident Injuries Act 2017, insurers must evaluate claims based on medical evidence, injury severity, and SIRA guidelines. This article explains how insurers determine compensation, what evidence matters, and steps to take if your claim is denied.
Key Factors in Insurer Assessments
NSW insurers assess ankle fracture claims by considering:
- Medical evidence confirming the injury (e.g., X-rays, MRI reports)
- Severity of the fracture (e.g., whether it's a simple or complex break)
- Impact on mobility and daily activities
- Alignment with SIRA guidelines for threshold injuries
- Contributory fault if the claimant was partially at fault
Insurers often refer to the Motor Accident Guidelines to determine if the injury meets the 'threshold injury' definition. For example, a simple ankle fracture with no long-term mobility issues may be classified as a threshold injury, limiting benefits after 52 weeks.
How SIRA Guidelines Apply
SIRA's guidelines state that threshold injuries include fractures of the lower limb bones, such as the tibia or fibula. However, insurers must assess whether the injury meets the 'spinal nerve-root qualification' under the Motor Accident Guidelines. This means a fracture must produce neurological signs (e.g., numbness, tingling) to qualify as a threshold injury.
For example, if a claimant has a broken ankle but no nerve damage, the injury may not qualify as a threshold injury. This distinction affects whether the claimant is eligible for weekly benefits or treatment and care payments.
Practical Steps for Claimants
To support your claim, gather:
- Medical records detailing the fracture and treatment
- Accident reports from police or the other party's insurer
- Witness statements or CCTV footage
- Income records to prove lost wages
- Communication with insurers (e.g., emails, letters)
If your claim is denied, request a written explanation. Insurers must provide reasons for rejecting a claim under the Motor Accident Injuries Act 2017. You may also seek a second medical opinion to challenge the insurer's assessment.
Time Limits and Dispute Options
NSW CTP claims must be submitted within 52 weeks of the accident, unless the claimant is under 18 or has a serious injury. For injuries classified as 'threshold injuries, ' benefits are generally limited to 52 weeks. If your claim is undervalued or denied, you can:
- Request a review from the insurer
- Seek mediation through the NSW Civil and Administrative Tribunal (NCAT)
- Consult a solicitor for legal advice
When to Seek Advice
If your ankle fracture is complex (e.g., involving multiple bones or ligaments), or if the insurer disputes the injury's severity, it's wise to seek legal advice. A solicitor can help you:
- Challenge the insurer's interpretation of SIRA guidelines
- File a formal dispute under the Motor Accident Injuries Act 2017
- Ensure you receive all entitled benefits
Final Steps
CTP claims depend on the accident date, injury type, and evidence. If you're unsure whether your claim meets the criteria, complete the quick, no obligation enquiry form to request contact about your circumstances.