Where a person's only injuries resulting from the accident are threshold injuries, weekly benefits and treatment and care generally cease after 52 weeks (ss 3.11 and 3.28).
Ankle fractures from car accidents in NSW are assessed under the Motor Accident Injuries Act 2017. The Personal Injury Commission (PIC) evaluates claims based on medical evidence, injury severity, and compliance with CTP scheme rules. If disputes arise, claimants must demonstrate that their injury meets the threshold for compensation and that all required documentation is submitted. This article explains what the PIC expects in Bankstown disputes, how to prepare for challenges, and when to seek legal advice.
What the PIC Considers for Ankle Fractures
The PIC uses the Motor Accident Guidelines to determine if an ankle fracture qualifies for compensation. Key factors include:
- Medical evidence: Detailed records from a medical practitioner confirming the fracture, its severity, and impact on mobility. X-rays, MRI scans, and clinical notes are critical.
- Threshold injury criteria: Under the Act, injuries must meet specific neurological or functional thresholds. For example, a fracture causing instability or prolonged immobility may qualify, while minor fractures without long-term effects may not.
- Alignment with SIRA guidelines: The PIC follows SIRA’s advice on what injuries are covered, including soft tissue injuries with spinal nerve-root involvement (per the guidelines).
Common Disputes in Bankstown CTP Claims
Disputes often arise when:
- The PIC questions whether the fracture meets the threshold injury definition.
- Medical records are incomplete or inconsistent.
- Claimants fail to provide evidence of income loss or care needs.
- There are delays in submitting documentation.
For example, if a claimant’s X-rays show a hairline fracture but their medical records lack clinical signs of instability, the PIC may dispute the injury’s severity. Claimants must ensure all evidence supports the injury’s impact.
Evidence and Practical Steps to Avoid Disputes
To strengthen a claim, gather:
- Medical records: From the first consultation to follow-ups, showing the injury’s progression and treatment.
- Accident details: Police reports, witness statements, and photos of the scene.
- Income and care records: Proof of lost wages, medical expenses, or need for assistance.
- Insurer correspondence: Keep copies of all communications with the at-fault driver’s insurer.
If the PIC requests additional information, respond promptly. Delays can lead to claims being rejected or delayed.
Time Limits and Dispute Resolution
Claims must be submitted within 52 weeks of the accident if only threshold injuries are involved (s 4.4 of the Motor Accident Injuries Act 2017). For non-threshold injuries, there is no strict time limit, but delays may weaken the claim.
If the PIC disputes a claim, you can:
- Submit additional evidence to clarify the injury’s impact.
- Request a review through the PIC’s internal process.
- Seek legal advice if the PIC’s decision is unsatisfactory.
Note that a challenge does not guarantee a changed decision. The PIC’s assessment is based on the evidence provided.
When to Seek Legal Advice
Consult a solicitor if:
- The PIC rejects your claim despite clear evidence.
- You face a dispute over injury severity or claim validity.
- You need help navigating the CTP scheme’s complex rules.
Legal professionals can help challenge the PIC’s decision, ensure all documentation is complete, and advise on next steps.
Next Steps
CTP claims depend on the accident date, injury type, and evidence submitted. If you’re in Bankstown and facing a dispute over an ankle fracture, ensure all records are complete and consider seeking legal guidance. Complete the quick, no obligation enquiry form to request contact about your circumstances.