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 your child was injured in a motor accident in Bathurst, understanding your dispute resolution options under NSW CTP rules is critical. This article explains how to challenge decisions about your child’s claim using SIRA’s official guidance, including internal reviews, mediation, and the Personal Injury Commission’s medical dispute pathway. Key considerations include time limits, evidence requirements, and how to navigate SIRA’s claims process for minors.
NSW CTP Rules for Child Injury Claims
New South Wales’ Motor Accident Injuries Act 2017 governs CTP claims, including those involving children. Under this framework, claims for injuries to minors are treated differently to ensure adequate support. SIRA (State Insurance Regulatory Authority) administers the scheme, and its guidelines outline what you can claim, including weekly income payments, treatment benefits, and compensation for permanent impairments.
For children, the 52-week statutory limit for weekly benefits applies only if their injuries are classified as 'threshold injuries', injuries that meet the soft-tissue definition under the Motor Accident Guidelines. If your child’s injury exceeds this threshold, you may be eligible for long-term compensation. However, disputes often arise over whether an injury qualifies as a threshold injury or if the 52-week limit applies.
Dispute Resolution Options
When disagreements occur about a child’s claim, several formal pathways exist:
- Internal review: SIRA allows claimants to request a review of a decision by a senior officer. This is the first step for disputes over claim assessments.
- Mediation: If the internal review does not resolve the issue, you may seek mediation through the NSW Civil and Administrative Tribunal (NCAT) or the Personal Injury Commission (PIC). Mediation is a voluntary process where a neutral third party helps negotiate a resolution.
- PIC medical dispute pathway: For disputes involving medical assessments of injury severity, the PIC’s medical dispute pathway provides a structured process to challenge or clarify the basis of a medical opinion. This is particularly relevant for claims involving long-term impairments or complex injuries.
Key Considerations for Child Claims
- Evidence requirements: SIRA requires detailed medical records, accident reports, and evidence of your child’s income or care costs. For disputes, you may need to provide additional documentation to challenge a decision.
- Time limits: While there is no strict time limit for initiating a claim, delays can affect your ability to challenge decisions. For example, disputes over the 52-week limit must typically be resolved within a reasonable timeframe after the claim is finalized.
- SIRA’s role: SIRA has the authority to assess claims and make decisions, but its processes are subject to review. If you believe a decision is incorrect, you can request a review or escalate the matter through the PIC.
Hypothetical Example
Imagine a 10-year-old child injured in a car accident in Bathurst. SIRA initially classifies the injury as a threshold injury, limiting weekly benefits to 52 weeks. However, your child’s medical team argues the injury involves a spinal nerve-root injury with neurological signs, which may qualify as a non-threshold injury under the Motor Accident Guidelines. In this case, you would need to submit updated medical evidence to challenge the initial assessment and request a review.
When to Seek Advice
Disputes over child injury claims can be complex, especially when involving medical assessments or long-term impairments. If you are unsure whether your child’s injury meets the threshold for long-term benefits, or if you need to challenge a decision, it is essential to seek guidance from a legal professional familiar with SIRA’s processes. While this article provides general information, individual circumstances may require tailored advice.
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