Understanding How Insurers Assess Aquaplaning Claims in NSW
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 were injured in an aquaplaning accident in New South Wales, especially in Western Sydney, you may wonder how insurers evaluate your claim. Aquaplaning occurs when a vehicle loses contact with the road surface due to water buildup, often during heavy rain. Under NSW CTP laws, insurers must assess claims based on specific legal criteria. This article explains what factors insurers consider, how to challenge decisions, and how SIRA guidelines apply to wet weather accidents.
Key Legal Framework for Aquaplaning Claims
The Motor Accident Injuries Act 2017 (MAIA) governs CTP claims in NSW. Insurers must determine whether your injuries meet the legal definition of a 'threshold injury' or qualify for damages. For aquaplaning accidents, the focus is on whether the accident was caused by a 'motor vehicle incident' under the MAIA. SIRA guidelines clarify that wet weather conditions, including aquaplaning, are considered when assessing claims.
Insurers evaluate claims by considering:
- Whether the accident occurred on a public road or motorway
- Whether the vehicle was in motion at the time of the incident
- Whether the injury resulted from the accident, not pre-existing conditions
- Whether the claimant has a valid 'motor vehicle incident' under the MAIA
Practical Steps and Evidence for Aquaplaning Claims
To support your claim, gather evidence that demonstrates:
- A detailed account of the accident, including weather conditions and road surface
- Police reports or accident statements
- Witness statements from drivers or pedestrians
- Medical records confirming injuries and their connection to the accident
- Photos of the accident scene, including water on the road and vehicle damage
Insurers often request medical evidence to confirm injuries meet the 'threshold injury' definition. This includes neurological signs or spinal nerve-root injuries, as outlined in SIRA's Motor Accident Guidelines. For example, if you suffered a soft-tissue injury from aquaplaning, your doctor must document neurological signs beyond radiculopathy to qualify for benefits.
Time Limits and Dispute Options
CTP claims must be submitted within 52 weeks of the accident, unless the claimant is a child or has a disability. If your insurer denies your claim, you can challenge the decision by:
- Requesting a review of the claim within 28 days of the denial
- Applying to the NSW Civil and Administrative Tribunal (NCAT) for a review
- Seeking independent medical opinions to dispute the insurer's assessment
SIRA provides a free claims assessment tool to help claimants understand their options. Insurers must also provide a written explanation for claim rejections, as required by the MAIA.
Example: How an Aquaplaning Claim Might Be Evaluated
Consider a cyclist in Western Sydney who was injured when a car aquaplaned on a wet motorway. The insurer would assess:
- Whether the accident occurred on a public road (yes)
- Whether the vehicle was in motion (yes)
- Whether the cyclist's injuries resulted from the accident (yes)
- Whether the injuries meet the threshold injury definition (medical evidence required)
If the cyclist's injuries are classified as a threshold injury, they may receive weekly benefits and treatment costs. However, if the injuries are deemed non-threshold, the insurer may limit benefits after 52 weeks, as per MAIA s 4.4.
When to Seek Legal Advice
Insurers may deny claims based on technicalities, such as disputing the accident's classification as a 'motor vehicle incident' or arguing that injuries are not threshold injuries. If your claim is denied, it's important to seek legal advice to:
- Challenge the insurer's interpretation of the MAIA
- Request a review of medical evidence
- Explore options for dispute resolution
Legal professionals can also help you understand whether your claim qualifies for additional benefits under the MAIA, such as income support or lifetime care.
Next Steps for Claimants
If you've been injured in an aquaplaning accident in NSW, take the following steps:
- Seek immediate medical attention to document injuries
- Gather evidence of the accident, including weather conditions
- Notify your insurer within 52 weeks of the incident
- Challenge any claim denial by requesting a review or contacting NCAT
- Consult a legal professional if your claim is rejected
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.