How NSW CTP Insurers Assess Liability 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).
If you suffered an ankle fracture in a car accident on the Central Coast, NSW CTP insurers evaluate your claim based on specific legal rules. The Motor Accident Injuries Act 2017 and SIRA guidelines determine whether you qualify for benefits. Insurers assess fault, the nature of the injury, and whether your ankle fracture meets the 'threshold injury' definition under the scheme. This article explains how insurers evaluate liability for ankle fractures and what steps to take.
Key Factors in Assessing Liability for Ankle Fractures
NSW CTP insurers consider several factors when determining liability for ankle fractures. First, they assess whether the accident involved a motor vehicle, as CTP insurance applies to motor vehicle accidents. Second, they evaluate whether the injury qualifies as a 'threshold injury' under the Motor Accident Guidelines. Ankle fractures are typically classified as threshold injuries, but insurers may require medical evidence to confirm this.
Insurers also examine fault. Under the Motor Accident Injuries Act 2017, claims are based on the fault of the at-fault driver, not the injured person. However, contributory fault from the injured person may reduce benefits. For example, if you were not wearing a seatbelt and suffered an ankle fracture, the insurer may adjust your claim.
Practical Steps for Claimants with Ankle Fractures
To support your claim, gather evidence such as medical records, accident reports, and witness statements. Medical records must clearly document the ankle fracture and its connection to the accident. SIRA guidelines require that injuries be assessed by a medical practitioner, so ensure your treating doctor provides detailed notes.
Preserve accident details, including police reports, photographs of the scene, and information about vehicle damage. If you were a pedestrian or cyclist, document how the accident occurred and any injuries sustained. Insurers may also request income records to assess weekly benefits for lost wages.
Time Limits and Dispute Options
Under NSW law, you must notify the at-fault driver’s insurer within 52 weeks of the accident to claim weekly benefits for threshold injuries. If your ankle fracture is not a threshold injury, you may still claim for other damages, but time limits apply. For example, claims for non-threshold injuries must be made within 52 weeks of the injury.
If your claim is disputed, you can request a review by the insurer or seek independent medical assessment. SIRA provides guidelines for resolving disputes, including the use of medical experts to evaluate injury severity. In some cases, claimants may need to escalate the matter to the NSW Civil and Administrative Tribunal (NCAT) if the insurer refuses to pay.
Example: How an Ankle Fracture Claim Might Be Assessed
Consider a scenario where a driver collides with a car on the Central Coast, causing the passenger to suffer an ankle fracture. The insurer would first confirm the accident involved a motor vehicle. They would then assess whether the ankle fracture meets the threshold injury definition under the Motor Accident Guidelines. If the fracture is confirmed as a threshold injury, the insurer would calculate weekly benefits based on the claimant’s income. However, if the claimant contributed to the accident (e.g., by not wearing a seatbelt), the benefits may be reduced.
When to Seek Legal Advice
While this article explains general principles, every claim depends on its own facts. If your ankle fracture claim is denied or you are unsure about your rights, seek legal advice. A solicitor can help you understand whether your injury qualifies for benefits, whether you can claim for non-threshold injuries, and how to challenge a disputed decision.
Next Steps
CTP entitlements and deadlines can depend on the accident date, injury type, and claim history. To request contact about your circumstances, complete the quick, no obligation enquiry form.