Burn Injuries, What the PIC Expects in Disputes (NSW-wide)
Where a person's only injuries resulting from the accident are threshold injuries, weekly benefits and treatment and care generally cease after 52 weeks (ss 3.11 and 3.28).
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've suffered burn injuries in a motor vehicle accident in New South Wales, understanding how the Personal Injury Commission (PIC) evaluates your claim is critical. The PIC assesses burn injuries based on medical evidence, injury severity, and compliance with the Motor Accident Injuries Act 2017. Disputes over burn injury claims often hinge on whether the injury meets the 'threshold injury' definition or requires further assessment. This article explains what the PIC expects in disputes, how claims are resolved, and practical steps to support your case.
NSW CTP Rules for Burn Injuries
Under the Motor Accident Injuries Act 2017 (MAIA), CTP claims cover injuries caused by motor vehicle accidents, including burns from vehicle fires or collisions. The PIC evaluates burn injuries using the Motor Accident Guidelines, which define 'threshold injuries' as those requiring medical treatment. For example, second-degree burns covering 10% of the body or first-degree burns with significant functional impact may qualify. However, the PIC requires clinical evidence such as medical reports, photographs, and specialist opinions to confirm the injury's severity.
Burn injuries are also assessed against the spinal nerve-root qualification. A spinal nerve-root injury producing neurological signs (even without radiculopathy) may still fall under the soft-tissue definition. This distinction is crucial in disputes where the injury's classification affects compensation.
Practical Steps and Evidence for Burn Injury Claims
To support a burn injury claim, gather the following:
- Medical records detailing the burn's depth (first, second, or third degree), location, and treatment
- Photographs of the injury and accident scene
- Witness statements confirming the incident
- Medical opinion from a specialist confirming the injury meets the threshold definition
- Evidence of treatment costs (e.g., hospital bills, physiotherapy records)
For example, if a claimant has second-degree burns on the arm and hand, the PIC will assess whether the injury requires medical treatment and impacts daily activities. A doctor's note stating the burn requires ongoing care would strengthen the claim.
Time Limits and Dispute Resolution
CTP claims must be submitted within 52 weeks of the accident (or 104 weeks for certain injuries under the MAIA). If the injury is classified as a 'threshold injury, ' benefits are generally limited after 52 weeks. However, if the injury results in long-term impairment (e.g., scarring affecting mobility), the PIC may extend benefits. Disputes over burn injury assessments are resolved through:
1. Internal Review by the PIC
Claimants can request an internal review of the PIC's decision. This process involves re-evaluating medical evidence and may lead to a revised assessment. However, a review does not guarantee a change in the decision.
2. Medical Dispute Pathway
If the PIC disputes the severity of the burn injury, claimants can seek a medical dispute resolution through the Personal Injury Commission. This involves a specialist medical opinion to determine whether the injury meets the threshold definition. The PIC considers this opinion when making a final decision.
3. Legal Assistance
If disputes persist, legal advice may be necessary. A solicitor can help challenge the PIC's decision or negotiate a settlement. However, legal action is rare and typically reserved for complex cases.
Key Considerations for Burn Injury Disputes
- Threshold injuries are limited to 52 weeks unless they result in long-term impairment
- Medical evidence is essential to prove the injury's severity and impact
- Disputes over burn classification often require specialist medical opinions
- Internal reviews and medical dispute pathways are available but do not guarantee a changed outcome
Example: Burn Injury Dispute Scenario
Consider a claimant who suffered burns to their arm and leg in a vehicle fire. The PIC initially classifies the injury as a 'threshold injury' and limits benefits after 52 weeks. The claimant disputes this, arguing the burns require ongoing physiotherapy. A medical review confirms the injury meets the threshold definition, leading to a revised assessment. This example highlights how medical evidence and the PIC's guidelines shape dispute outcomes.
Next Steps for Claimants
If you're involved in a burn injury dispute, take the following actions:
- Document all medical treatment and keep records of expenses
- Request an internal review of the PIC's decision
- Seek medical dispute resolution if the injury's severity is contested
- Consult a solicitor if disputes escalate or involve complex legal issues
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.
The PIC evaluates burn injuries in NSW CTP claims based on medical evidence, injury severity, and compliance with the Motor Accident Injuries Act 2017. Disputes are resolved through internal reviews, medical dispute pathways, and legal assistance. Understanding the PIC's expectations and gathering strong evidence are critical to securing fair compensation.