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).
Burn injuries caused by vehicle fires in New South Wales are covered under the Compulsory Third Party (CTP) insurance scheme. Families and caregivers need to understand how to claim compensation for medical expenses, lost income, and care costs. The NSW government’s State Insurance Regulatory Authority (SIRA) oversees CTP claims, and burn injuries are assessed based on medical evidence and the Motor Accident Injuries Act 2017. This article explains what families should know about CTP claims for burn injuries, including how to document care needs and time limits for claims.
What CTP Compensation Covers for Burn Injuries
Under the CTP scheme, burn injuries caused by vehicle fires are eligible for compensation. Families may claim:
- Medical treatment costs (including specialist care, hospital visits, and therapy)
- Weekly income benefits if the injured person cannot work
- Caregiver expenses such as hiring help or family members taking time off work
- Lifelong care costs if the injury results in permanent disability
SIRA’s guidelines emphasize that burn injuries are assessed based on medical evidence, including the severity of the burn and long-term impact. Families should gather documentation such as medical reports, receipts for treatment, and proof of income to support claims.
Practical Steps for Families and Caregivers
- Seek immediate medical attention to document the injury and its effects.
- Keep detailed records of all medical treatments, including specialist consultations and rehabilitation sessions.
- Track caregiver expenses such as lost wages, transportation costs, or home modifications.
- Notify the at-fault driver’s insurer through SIRA’s claims process.
- Submit claims within 52 weeks if the injury is classified as a 'threshold injury' (minor injuries with no long-term impact).
Families should also consider how the injury affects daily life. For example, if a child is burned in a vehicle fire, caregivers may need to take time off work to manage medical appointments, which can impact income. SIRA allows for claims to cover these indirect costs.
Time Limits and Dispute Options
CTP claims must be submitted within 52 weeks of the accident if the injury is classified as a 'threshold injury.' However, burn injuries are not automatically considered threshold injuries. Under the Motor Accident Injuries Act 2017, only injuries with minimal long-term impact fall into this category. If the burn results in permanent scarring, nerve damage, or mobility issues, the 52-week limit does not apply, and benefits may continue indefinitely.
If a family disputes a SIRA decision, they can apply for a review by the NSW Civil and Administrative Tribunal (NCAT). This process allows families to challenge assessments of injury severity or claim eligibility. It’s important to act quickly, as delays can affect the outcome.
Example: Caregiver Costs for a Burn Injury
Consider a scenario where a family member is burned in a vehicle fire and requires 24-hour care. The caregiver may need to reduce work hours or leave employment, resulting in lost income. SIRA allows claims for this lost income, provided the caregiver provides evidence such as payslips or employer statements. Families should also document the time spent caregiving, as this affects the total compensation amount.
When to Seek Legal Advice
While SIRA provides a claims process, families may need legal assistance to navigate complex situations. For example, if the accident involves multiple parties (such as a hit-and-run or a dispute over fault), a lawyer can help ensure all claims are submitted correctly. Legal advice is also recommended if the injury results in long-term care needs or if the claim is denied.
Next Steps for Families
Families and caregivers should start by contacting SIRA directly to submit a claim. If the injury is severe or the claim is denied, seeking legal advice can help ensure all options are explored. Remember, every claim depends on its own facts, and the process can vary based on the injury’s severity and circumstances.
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