When a child is injured in a motor accident in New South Wales, dispute resolution options depend on the type of claim and evidence available. The NSW Compulsory Third Party (CTP) scheme governs most claims, but families may need to navigate disputes over compensation, treatment, or benefit eligibility. This article explains how to resolve conflicts under the Motor Accident Injuries Act 2017, including steps to take with the State Insurance Regulatory Authority (SIRA) and when to seek legal advice.
NSW CTP Rules for Child Injury Claims
The CTP scheme covers injuries to children in motor accidents, but the process differs depending on whether the injury meets the 'threshold injury' definition. Under the Motor Accident Guidelines, a threshold injury includes soft tissue injuries like whiplash or fractures that require medical treatment. For children, the threshold is lower due to their developing bodies, meaning even minor injuries may qualify for benefits.
If a child’s injury is classified as a threshold injury, the injured person is entitled to weekly income benefits and treatment and care benefits for up to 52 weeks. After this period, benefits may stop unless the injury results in long-term impairment. Families must submit medical evidence, such as a GP report or specialist opinion, to confirm the injury meets the threshold.
Practical Steps for Resolving Disputes
Disputes often arise when families disagree with the insurer’s assessment of the injury’s severity or the amount of compensation. To resolve these issues, follow these steps:
- Contact SIRA directly - The State Insurance Regulatory Authority handles claims under the CTP scheme. Families can request a review of the insurer’s decision by submitting fresh evidence, such as a second medical opinion.
- Use the Personal Injury Commission (PIC) pathway - If the insurer refuses to reconsider its decision, families can escalate the matter to the PIC. The PIC reviews medical evidence and may order an independent assessment of the injury.
- Seek legal advice - A solicitor can help families challenge the insurer’s decision, especially if the claim involves complex issues like long-term impairment or disputes over the 52-week benefit limit.
Time Limits and When to Act
Time is critical in CTP claims. Families must notify the insurer of the injury within 52 weeks of the accident, or the claim may be denied. If the injury is not a threshold injury, the 52-week period applies to the benefits, but the family can still pursue a common law damages claim if the injury meets the 'whole person impairment' threshold.
Disputes over the insurer’s assessment must be resolved within 52 weeks of the injury being reported. If the family misses this deadline, they may lose the right to claim benefits. However, the 52-week period does not apply to disputes about the injury’s severity or the amount of compensation.
Example: Resolving a Benefit Dispute
Consider a scenario where a 10-year-old child sustains a minor head injury in a car accident. The insurer denies the claim, arguing the injury does not meet the threshold. The family submits a medical report from a paediatrician confirming the injury requires treatment, leading to a successful claim. If the insurer still disputes the injury’s severity, the family can request a review by the PIC.
When to Seek Legal Advice
Families should consult a solicitor if:
- The insurer refuses to pay benefits without a clear explanation.
- The injury involves long-term impairment or permanent disability.
- The family is unsure whether the injury meets the threshold injury definition.
- The 52-week benefit period has expired, but the family believes the injury warrants ongoing support.
Legal professionals can help families understand their rights under the Motor Accident Injuries Act 2017 and ensure all evidence is submitted correctly. They can also assist with disputes over the insurer’s interpretation of the guidelines.
Final Steps for Families
If a dispute arises over a child’s injury claim, families should act quickly. Contacting SIRA first is often the best starting point, as the insurer must respond within 52 weeks. If the dispute continues, the Personal Injury Commission can provide an independent review. In complex cases, seeking legal advice ensures families understand all their options under NSW law.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.