Understanding Liability in NSW CTP Claims for Ankle Fractures
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 sustained in a car accident in Albury, NSW, are assessed by Compulsory Third Party (CTP) insurers under the Motor Accident Injuries Act 2017. Insurers determine liability based on whether the accident was caused by another party’s negligence, not on whether the claimant was at fault. This means that even if you were not driving, you may still be entitled to compensation if another driver’s actions caused the crash. The insurer will review the circumstances, including police reports, witness statements, and medical evidence, to establish who was at fault. This assessment is critical because liability determines whether you can access CTP benefits, including treatment and care, weekly income payments, and, in some cases, damages.
How Insurers Evaluate Ankle Fractures in CTP Claims
Insurers assess ankle fractures by examining the nature of the injury, how it occurred, and whether it resulted from the motor vehicle accident. A fracture is not automatically compensable; it must be shown to have arisen from the impact of the crash. Insurers rely on medical evidence, including diagnostic imaging (X-rays, MRI), clinical notes, and assessments from medical practitioners, to confirm that the fracture is consistent with a motor vehicle collision. For example, a spiral fracture of the tibia may suggest rotational forces typical in a side-impact crash, which supports a causal link to the accident.
Insurers also consider whether the injury was pre-existing or aggravated by the accident. If you had a prior ankle condition, the insurer may argue the fracture was not caused by the accident. Medical evidence must clearly show that the accident was the primary cause of the injury. The Motor Accident Injuries Regulation 2017 sets out the framework for assessing injury causation, and insurers must follow the Motor Accident Guidelines issued by SIRA, which provide standards for evaluating injury severity and causation.
Key Evidence That Supports a Liability Claim
To strengthen a claim for an ankle fracture, gather and preserve the following evidence:
- A police report, if one was filed at the scene
- Photographs of the vehicle damage, road conditions, and any visible injuries
- Medical records, including emergency department notes, radiology reports, and follow-up assessments
- Witness contact details and statements
- A record of all communications with the insurer, including emails and letters
- Proof of lost income, if applicable
Insurers may request a review by an independent medical assessor to verify the injury and its link to the accident. It is important to seek treatment promptly and to keep all medical appointments, as delays may be used to challenge the injury’s timing or severity.
Time Limits and Procedural Requirements
There is a strict time limit to make a claim under CTP. You must notify the insurer within 6 months of the accident. While you may still make a claim after this period, it may be refused unless you can show a valid reason for the delay. The claim must be made within 3 years of the accident, or the right to claim may be lost.
If an insurer denies liability or offers a settlement you believe is too low, you may request a review. If the dispute remains unresolved, you can apply to the NSW Civil and Administrative Tribunal (NCAT) for a determination. This process allows you to present evidence and have a decision made by an independent tribunal.
When to Seek Independent Advice
A claim for an ankle fracture may involve complex issues, such as whether the injury qualifies as a threshold injury, whether you are entitled to damages, or whether the insurer’s assessment of liability is correct. If you believe your claim is being undervalued or denied without proper grounds, it is advisable to seek independent legal advice. A solicitor can help you understand your rights, review the insurer’s assessment, and assist in negotiating a fair outcome or initiating a formal dispute.
Hypothetical Example
A 42-year-old passenger in a car that was struck from behind in Albury on 15 March 2026 sustained a displaced fracture of the ankle. The driver of the other vehicle admitted fault at the scene. The claimant was treated in hospital and underwent surgery. The insurer initially offered a settlement based on treatment and care benefits only, arguing that the injury was a threshold injury. After a review by an independent medical assessor confirmed the injury met the threshold criteria and that the fracture was caused by the crash, the claimant was able to access additional benefits and damages.
Next Steps
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.