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 the Blue Mountains or Nepean regions of New South Wales, understanding how to resolve disputes over compensation is critical. The NSW Compulsory Third Party (CTP) scheme governs claims, but disagreements over medical assessments, claim value, or payment timing can arise. This article explains how to navigate dispute resolution options under the Motor Accident Injuries Act 2017, focusing on practical steps for rural claimants.
How SIRA Handles Child Injury Claims
The State Insurance Regulatory Authority (SIRA) administers CTP claims in NSW. For children, SIRA evaluates injuries based on the Motor Accident Guidelines, which define threshold injuries and long-term impairments. Parents or carers must submit medical evidence, such as reports from pediatricians or specialists, to support claims. SIRA’s process for child claims includes:
- Assessing the child’s medical condition and treatment needs
- Calculating weekly income payments or lump sum compensation
- Reviewing evidence for disputes over injury severity or claim validity
In rural areas like the Blue Mountains, claimants may face challenges accessing SIRA offices or specialist medical reviewers. SIRA offers remote submission options and can arrange medical assessments through approved providers. However, disputes over the accuracy of medical reports or the interpretation of guidelines are common.
Dispute Resolution Options for Child Claims
If you disagree with SIRA’s decision on a child’s claim, you have specific options to challenge the outcome:
1. Internal Review by SIRA
You can request an internal review of the claim assessment. This involves:
- Submitting new evidence, such as additional medical records or expert opinions
- Clarifying misunderstandings in the original assessment
- Demonstrating how the claimant’s circumstances differ from the guidelines
SIRA must respond to an internal review within 28 days. This process is free and does not require legal representation, though it can be complex for parents unfamiliar with medical terminology.
2. Personal Injury Commission (PIC) Medical Dispute Pathway
If the dispute involves a medical assessment, you can escalate it to the PIC’s medical dispute pathway. This is a formal process where independent medical experts review the claim. Key steps include:
- Applying for a medical review through SIRA
- Providing detailed records of the child’s treatment and recovery
- Waiting for the PIC to schedule an independent assessment
This pathway is essential for disputes over whether a child’s injury meets the threshold for long-term compensation. However, it does not guarantee a change in the decision, the PIC’s review is advisory, and SIRA retains the final authority.
3. Legal Action as a Last Resort
If disputes persist, parents may seek legal advice to challenge SIRA’s decision in the NSW Civil and Administrative Tribunal (NCAT). This is a formal process that requires a solicitor and is typically reserved for cases where:
- The claimant believes SIRA misinterpreted the law
- There is evidence of procedural errors in the claim assessment
- The child’s injuries were not properly evaluated
Legal action is not common for child claims due to the complexity of medical evidence and the high cost of litigation. However, it is an option for claimants who believe their child’s rights under the Motor Accident Injuries Act 2017 were violated.
Practical Steps for Rural Claimants
Parents in the Blue Mountains and Nepean regions should take the following steps to manage disputes effectively:
1. Document Everything
Keep detailed records of:
- All medical reports and treatment records
- Communication with SIRA, including dates and summaries of calls
- Expenses related to the child’s recovery, such as therapy sessions or travel costs
2. Seek Independent Medical Opinions
If you believe SIRA’s assessment is incorrect, obtain a second opinion from a pediatrician or specialist. This can strengthen your case during internal reviews or legal action.
3. Use SIRA’s Rural Support Services
SIRA provides support for claimants in remote areas. Contact their regional office to arrange for medical assessments or to request assistance with claim forms. Some offices offer translation services for non-English speakers.
4. Consider Mediation
SIRA may offer mediation as an alternative to legal action. A mediator can help both parties reach an agreement without escalating the dispute to NCAT.
Example Scenario: Dispute Over Threshold Injury
Imagine a child who suffered a soft-tissue injury in a car accident. SIRA initially denied a long-term claim, arguing the injury did not meet the threshold. The parent disputes this, providing evidence of ongoing pain and limited mobility. They request an internal review, submit a new MRI scan, and argue the injury qualifies under the guidelines. SIRA re-evaluates and approves the claim, demonstrating how evidence and persistence can resolve disputes.
When to Seek Legal Advice
Consult a solicitor if:
- SIRA refuses to reconsider a claim despite new evidence
- The child’s injuries are not being properly assessed
- You believe SIRA is acting unfairly or in bad faith
Legal professionals can help draft formal objections, challenge medical assessments, or prepare for NCAT proceedings. However, legal action should be a last resort due to the time and cost involved.
Final Steps for Parents and Carers
Disputes over child motor accident claims can be resolved through SIRA’s internal processes, medical reviews, or legal action. In rural areas like the Blue Mountains and Nepean, it is essential to act quickly, document all evidence, and seek support from SIRA or legal professionals. Every claim depends on its own facts, and the right approach will vary based on the child’s injuries and the circumstances of the accident.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.