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 NSW are treated as threshold injuries under the Motor Accident Injuries Act 2017. The Personal Injury Commission (PIC) evaluates claims based on medical evidence, treatment costs, and functional impact. This article explains what the PIC expects when disputes arise over ankle fractures in CTP claims.
Medical Evidence for Ankle Fracture Claims
The PIC requires detailed medical documentation to assess ankle fractures. This includes:
- A confirmed diagnosis of a fracture via X-ray or MRI
- A clinical assessment of neurological signs, such as spinal nerve-root injuries
- A record of treatment received, including physiotherapy, braces, or surgery
- Evidence of how the injury affects daily activities, such as walking or standing
SIRA guidelines emphasize that medical records must clearly link the fracture to the accident. For example, a doctor's report should specify the mechanism of injury (e.g., impact from a car collision) and note any restricted movement or pain.
How SIRA Assesses Functional Impact
SIRA evaluates ankle fractures based on their effect on daily life. Key factors include:
- Ability to walk, stand, or climb stairs
- Pain levels during routine activities
- Need for assistive devices like crutches
- Impact on work or study (e.g., reduced hours or time off)
The PIC uses the Motor Accident Guidelines to determine if the injury meets the 'threshold injury' definition. For instance, a fracture with minimal swelling and full recovery within 52 weeks may qualify for weekly benefits, while more severe cases may access additional compensation.
Common Disputes and Resolution Steps
Disputes often arise over:
- Whether the fracture meets threshold injury criteria
- The extent of treatment costs claimed
- The link between the injury and the accident
To resolve disputes, claimants should:
- Submit a detailed medical report from a registered medical practitioner
- Provide evidence of treatment costs (e.g., receipts for physiotherapy)
- Complete the PIC's internal review form if dissatisfied with a decision
- Seek independent medical assessment if the PIC challenges the claim
The PIC may request a second opinion from a medical expert. However, a challenge does not guarantee a changed decision. Claimants should note that disputes typically take 6-12 months to resolve, depending on the complexity of the case.
Practical Steps for Claimants
To strengthen a claim:
- Document all medical appointments and treatment plans
- Keep records of how the injury affects work or study (e.g., time off, reduced productivity)
- Preserve accident details, such as police reports or witness statements
- Notify your insurer within 52 weeks of the accident (as per the 52-week statutory benefit rules)
If the PIC disputes the claim, it's important to understand that the burden of proof lies with the claimant. Medical evidence must clearly demonstrate the injury's impact and link it to the accident.
When to Seek Legal Advice
Legal assistance may be needed if:
- The PIC denies the claim despite medical evidence
- There are disputes over treatment costs or benefits
- The claimant is unsure about their rights under the Motor Accident Injuries Act 2017
A solicitor can help navigate the PIC's internal review process and ensure all evidence meets legal standards. However, legal advice is not a guarantee of success, as each case depends on its unique facts.
Time Limits and Next Steps
CTP claims must be submitted within 52 weeks of the accident, although extensions may be granted for valid reasons. If the PIC disputes the claim, claimants have 6-12 months to resolve the matter through internal review or mediation. Delaying evidence collection or failing to meet deadlines can jeopardize entitlements.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.