Understanding Ankle Fractures in NSW CTP Claims
An ankle fracture sustained in a car accident in Greater Sydney may give rise to a claim under the NSW Compulsory Third Party (CTP) insurance scheme. The scheme, governed by the Motor Accident Injuries Act 2017 (MAIA), provides financial support for injuries caused by motor vehicle accidents, regardless of fault. SIRA, the State Insurance Regulatory Authority, administers the CTP scheme and provides guidance on how claims are assessed, including for lower limb injuries such as ankle fractures. The rules are the same across Greater Sydney as they are elsewhere in NSW, with no regional variation in entitlements. The outcome depends on the nature of the injury, the treatment received, and whether the injury meets the threshold for damages under the MAIA.
How SIRA Applies the Rules to Ankle Fractures
SIRA explains that an ankle fracture is considered a physical injury that may qualify for statutory benefits under the CTP scheme. These benefits include treatment and care benefits, which cover the cost of medical treatment, rehabilitation, and allied health services. If the fracture results in a loss of income, the injured person may also be eligible for weekly income payments. SIRA’s guidelines state that treatment must be reasonable and necessary, and that medical practitioners must provide documentation supporting the need for treatment and its connection to the accident.
An ankle fracture may also be considered a threshold injury if it is classified as a soft tissue injury or a fracture not involving a major joint, provided it does not meet the threshold for damages. Under the MAIA, a person may only claim damages for pain and suffering and future care if they have a threshold injury, which includes a fracture that causes a permanent impairment. The Motor Accident Guidelines specify that a fracture must result in a whole person impairment (WPI) of at least 10% to qualify for damages. SIRA assesses WPI using the Australian Institute of Health and Welfare (AIHW) impairment tables and medical evidence from a qualified assessor.
Practical Steps and Evidence That Matter
To support a claim for an ankle fracture, the injured person should take the following steps as soon as possible:
- Seek medical treatment immediately and keep all records, including diagnostic imaging (X-rays, MRI), treatment notes, and rehabilitation plans.
- Notify the CTP insurer of the accident and injury within a reasonable time, ideally within 30 days, to preserve rights under the MAIA.
- Preserve any evidence related to the accident, including photographs of the vehicle damage, the scene, and the injury; witness contact details; and any correspondence with the insurer.
- Maintain records of lost income, out-of-pocket expenses, and time off work.
SIRA notes that a claim may be denied if the injury is not shown to have resulted from the motor accident. Therefore, medical evidence must clearly link the fracture to the crash, particularly if there was a delay in seeking treatment. A medical practitioner’s report stating that the injury is consistent with a motor vehicle impact is critical.
Time Limits and Dispute Options
There is a 3-year limitation period under the Limitations Act 1969 (NSW) for initiating legal proceedings to claim damages for an ankle fracture. This period begins from the date of the accident. While statutory benefits such as treatment and care payments may be available for up to 52 weeks if the injury is a threshold injury, damages claims must be commenced within the 3-year window. SIRA advises that claims for damages should not be delayed, as failure to act within this time may result in a permanent bar to legal action.
If an insurer denies a claim or disputes the extent of the injury, the injured person may request a review under the MAIA. SIRA provides a formal dispute resolution process, and if unresolved, the matter may be referred to the Civil and Administrative Tribunal (NCAT) for determination. The injured person may also seek independent legal advice to assess the strength of the claim and the potential for a damages award.
Hypothetical Example: Ankle Fracture in a Sydney Car Accident
A 38-year-old driver in Sydney was involved in a rear-end collision on the M4 Motorway in October 2024. The impact caused a displaced fracture of the right ankle, requiring surgery and a 12-week period in a cast. Medical records confirmed the injury was consistent with a motor vehicle impact. The person was unable to work for 10 weeks and received weekly income payments under the CTP scheme. After recovery, a qualified medical assessor determined a WPI of 14%. As this exceeds the 10% threshold, the person may be eligible to claim damages for pain and suffering, loss of earnings, and future care needs, provided the claim is made within 3 years of the accident.
Next Steps
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