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're dealing with a chronic pain claim after a motor accident in NSW, understanding your dispute resolution options is critical. Under the NSW Compulsory Third Party (CTP) scheme, chronic pain is a threshold injury eligible for statutory benefits, but disputes over its severity or entitlement can arise. This article explains how to challenge a decision, what evidence matters, and when to seek legal help in Bankstown.
How SIRA Handles Chronic Pain Claims
The State Insurance Regulatory Authority (SIRA) administers NSW CTP claims. For chronic pain, SIRA assesses whether the injury meets the 'threshold injury' definition in the Motor Accident Injuries Act 2017. This requires a medical report confirming ongoing pain that limits daily activities, even if no structural damage is found. Chronic pain claims in Bankstown are typically reviewed by SIRA's internal team or referred to the Personal Injury Commission (PIC) for medical disputes.
Dispute Resolution Pathways
If your chronic pain claim is disputed, you have several options:
- Internal review: Request SIRA to reassess your claim with new evidence.
- Medical dispute pathway: If the PIC disagrees with a medical report, you can challenge the assessment through a formal review.
- Independent medical opinion: Seek a second opinion from a registered medical practitioner to support your case.
- Mediation: SIRA offers mediation to resolve disputes without escalating to a tribunal.
Practical Steps for Injured People
To strengthen your claim:
- Document all pain-related limitations, such as difficulty sleeping or work absences.
- Keep records of medical consultations, prescriptions, and therapy sessions.
- Preserve accident details like police reports, witness statements, and photographs.
- Submit a detailed claim form with specific examples of how pain affects your life.
Time Limits and Key Deadlines
You must notify SIRA of your claim within 52 weeks of the accident. If your claim is disputed, you can request a review within 28 days of receiving the decision. Chronic pain claims often take longer to resolve due to the need for medical assessments, so acting quickly is essential.
When to Seek Legal Advice
Consult a solicitor if:
- SIRA denies your claim without clear reasoning.
- You disagree with the PIC's medical opinion.
- You need help drafting a dispute submission.
- You want to challenge a decision through the NSW Civil and Administrative Tribunal (NCAT).
Example Scenario
Consider a Bankstown resident who suffered a whiplash injury in a low-speed collision. After 12 months, they develop chronic neck pain affecting sleep and work. SIRA initially denies the claim, arguing the pain is 'non-physical'. The injured person can dispute this by providing a doctor's report linking the pain to the accident and evidence of functional limitations.
Next Steps
Chronic pain claims in NSW CTP disputes require careful documentation and timely action. While SIRA handles most claims internally, disputes often involve medical reviews and legal processes. Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.