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 a cervical disc injury in a motor vehicle accident in NSW, understanding your dispute resolution options is critical. Under the Motor Accident Injuries Act 2017 (MAIA), claims for cervical spine injuries must be assessed against specific medical and legal criteria. This article explains how to challenge a decision, what evidence matters, and how SIRA handles disputes involving cervical disc injuries.
How SIRA Handles Cervical Disc Injury Claims
SIRA evaluates claims based on the Motor Accident Guidelines, which define threshold injuries. For cervical disc injuries, a spinal nerve-root injury producing neurological signs (other than radiculopathy) may still qualify as a soft-tissue injury. However, radiculopathy requires specific clinical signs under the guidelines. If your injury doesn't meet these criteria, SIRA may dispute your claim.
If you disagree with SIRA's assessment, you can request an internal review within 28 days of receiving their decision. This process allows you to submit new evidence or challenge the interpretation of medical records. For example, if your MRI shows disc degeneration but no radiculopathy, SIRA might classify it as a non-threshold injury, even if you experience chronic neck pain.
Key Dispute Resolution Options
- Internal Review: SIRA must consider your request for a review within 28 days. This is the first step if you believe your claim was incorrectly assessed.
- Personal Injury Commission (PIC) Medical Dispute Pathway: If your injury involves a spinal nerve-root injury or radiculopathy, you can refer the matter to the PIC. This body specializes in complex spinal injuries and can provide an independent medical opinion.
- Legal Challenge: If SIRA refuses to reconsider your claim, you may need to seek legal advice to challenge their decision in the NSW Civil and Administrative Tribunal (NCAT). This is a last resort and requires evidence that SIRA misinterpreted your medical records or applied the guidelines incorrectly.
Practical Steps for Claimants
To resolve disputes effectively, gather:
- Detailed medical records showing your injury's severity
- Imaging reports (MRI/CT scans) with radiologist notes
- Doctor's notes explaining how your injury affects daily activities
- Evidence of pre-accident health (e.g., pre-existing conditions)
If your claim was denied, request a written explanation of why your injury doesn't meet the threshold injury criteria. This will help you determine whether to pursue an internal review or seek legal advice.
Time Limits and When to Seek Advice
You have 28 days from receiving SIRA's decision to request an internal review. If you miss this deadline, you may lose the right to challenge their assessment. For complex spinal injuries, it's advisable to consult a solicitor within 30 days of receiving a decision, especially if your injury involves radiculopathy or spinal nerve-root damage.
Example of a SIRA Dispute
Consider a claimant who suffered a cervical disc herniation after a collision. Their MRI shows disc protrusion but no radiculopathy. SIRA classifies this as a non-threshold injury, denying compensation. The claimant challenges this by submitting a specialist report showing that the disc injury caused chronic pain and reduced mobility. SIRA then re-evaluates the claim based on the updated evidence.
Next Steps
Time limits and procedural requirements vary depending on your injury type and claim history. To request contact about your circumstances, complete the quick, no obligation enquiry form.