Understanding Burn Injury Claims in NSW CTP Claims
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 sustained in a motor vehicle fire in New South Wales are governed by the Motor Accident Injuries Act 2017 (MAIA), which sets out the framework for compensation through the Compulsory Third Party (CTP) insurance scheme. If a vehicle fire causes burns, the injured person may be entitled to treatment and care benefits, weekly income payments, and, in some cases, damages for pain and suffering. Disputes may arise over the extent of injury, the need for ongoing treatment, or the amount of compensation offered. The dispute resolution process is managed through the State Insurance Regulatory Authority (SIRA), which oversees claims and provides guidance on resolving disagreements between claimants and insurers.
How SIRA Manages Disputes in Burn Injury Claims
SIRA is the independent authority responsible for administering the CTP scheme in NSW. When a claim for burn injuries from a vehicle fire is disputed, such as a refusal to pay for specialist wound care, a challenge to the level of impairment, or disagreement over the need for long-term rehabilitation, SIRA provides a structured pathway for resolution. The process begins with an internal review by the insurer, which must be completed within 28 days of a written request. If the claimant remains dissatisfied, they may escalate the matter to SIRA for formal review. SIRA does not decide claims on its own but ensures that insurers follow the MAIA and the Motor Accident Injuries Regulation 2017.
For burn injuries, SIRA considers the nature and severity of the injury, including scarring, functional impairment, and psychological impact. The assessment must be based on medical evidence and the Motor Accident Guidelines, which define how impairment is calculated for burns. A claimant may be assessed for whole person impairment (WPI) if the burn has caused lasting physical or mental effects. SIRA’s role is to ensure that decisions are made fairly and in accordance with law, not to determine entitlements independently.
Practical Steps and Evidence That Matter
To resolve a dispute over a burn injury from a vehicle fire, claimants should gather and preserve the following evidence:
- Medical records from emergency departments, burns units, and follow-up appointments, including documentation of skin grafts, infection episodes, and rehabilitation.
- Photographs of the burn injury at different stages of healing, taken with date and time metadata.
- A detailed statement from the treating medical practitioner outlining the diagnosis, treatment plan, and prognosis.
- Evidence of loss of income, including payslips, tax returns, and a letter from the employer confirming reduced capacity.
- A copy of the accident report, including details of the fire, vehicle damage, and any witness statements.
- Correspondence with the insurer, including written requests for review and responses.
A claimant who has sustained a burn injury in a vehicle fire must also be aware that the nature of the injury may affect eligibility for damages. If the injury is classified as a threshold injury under MAIA, damages may be limited unless the claimant meets the threshold for serious injury. For burns, this includes evidence of permanent scarring, loss of function, or psychological trauma that significantly impacts daily life.
Dispute Resolution Pathways and Time Limits
If an insurer refuses to pay for treatment, disputes the level of impairment, or offers a settlement that is not acceptable, the claimant may pursue one of several dispute resolution options. The first step is to request an internal review from the insurer. If that fails, the claimant may apply to the Personal Injury Commission (PIC) for a review of the decision. The PIC is the independent tribunal that handles disputes under the CTP scheme. It can review decisions on treatment and care benefits, weekly income payments, and damages.
The PIC process allows for a medical dispute to be resolved through an independent assessment. If a claimant disagrees with the insurer’s medical assessment of their burn injury, they may request a second opinion from a medical practitioner approved by the PIC. The PIC may also order a medical examination if there is a dispute over the extent of scarring, nerve damage, or functional loss.
Time limits apply. A claimant must apply to the PIC within 12 months of receiving a decision from the insurer. Failure to meet this deadline may result in the claim being barred. The internal review must be requested within 28 days of receiving the insurer’s decision. These timeframes are strict and must be adhered to.
How Burn Injury Claims Differ from Other CTP Claims
Burn injuries from vehicle fires differ from other CTP injuries in several key ways. Unlike soft-tissue injuries, which are often assessed under the threshold injury provisions, burn injuries may result in permanent scarring, disfigurement, and long-term psychological effects. These factors may support a claim for damages even if the injury is not classified as serious under the threshold test.
Additionally, burns may require complex and ongoing treatment, including skin grafts, physiotherapy, and mental health support. The cost and duration of this care may lead to disputes over the extent and duration of treatment and care benefits. SIRA’s guidelines emphasise that treatment must be reasonable and necessary, and insurers are not required to fund all forms of alternative therapy unless supported by medical evidence.
A key distinction is that burns may involve a higher risk of infection, delayed healing, and complications such as contractures. These factors must be documented in medical records and may influence the assessment of WPI. For example, a burn that results in limited mobility in a hand may be assessed for functional impairment, which can increase the value of a claim.
When to Seek Independent Advice
A dispute over a burn injury claim should not be resolved without independent legal or medical advice. The process of challenging a decision on treatment, impairment, or damages can be complex, and the outcome depends on the strength of the evidence. A claimant should not assume that a dispute will be resolved in their favour, nor should they expect that a challenge will result in a higher payment.
The Personal Injury Commission process is not a guaranteed pathway to a better outcome. A claimant may still receive a decision that upholds the insurer’s original position. However, the process provides a formal opportunity to present evidence and have the decision reviewed by an independent body.
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