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).
NSW insurers assess liability for chronic pain claims by evaluating medical evidence, treatment records, and how the injury impacts daily life. This article explains the process under the Motor Accident Injuries Act 2017 and SIRA guidelines, focusing on claims in Bankstown. Understanding how insurers assess pain claims is critical for injured road users seeking compensation.
How NSW CTP Insurers Evaluate Chronic Pain Claims
NSW insurers assess liability for chronic pain by examining medical documentation that confirms the injury's connection to the accident. Under the Motor Accident Injuries Act 2017, claims must demonstrate a threshold injury, defined as a condition requiring treatment and resulting in ongoing impairment. Chronic pain claims often hinge on evidence like medical reports, pain management records, and statements from healthcare professionals.
SIRA guidelines emphasize that insurers must consider the 'whole person impairment' when assessing long-term pain. This includes evaluating how the injury affects mobility, work capacity, and quality of life. For example, if a motor accident caused a spinal nerve injury leading to chronic pain, the insurer would review MRI scans, physiotherapy records, and specialist opinions to determine if the injury meets the threshold.
Evidence Required for Chronic Pain Claims
To support a chronic pain claim, injured individuals must provide:
- Detailed medical records showing the injury's link to the accident
- Evidence of ongoing treatment, such as prescriptions or therapy sessions
- Statements from doctors explaining how the pain limits daily activities
- Witness accounts or accident reports confirming the incident
Insurers may also request a medical assessment to verify the injury's severity. For instance, a claimant with persistent lower back pain following a car crash would need to show that the pain is not due to pre-existing conditions or lifestyle factors.
Time Limits and Dispute Resolution
Claims must be made within 52 weeks of the accident under the Motor Accident Injuries Act 2017. However, chronic pain claims may require extensions if the injury's full impact is not immediately apparent. If an insurer disputes liability, claimants can request a review by the NSW Civil and Administrative Tribunal (NCAT) or seek independent medical opinions.
When to Seek Legal Advice
Chronic pain claims often involve complex medical and legal assessments. In Bankstown, injured road users should consult a solicitor if:
- The insurer denies the claim without clear reasoning
- Medical evidence is incomplete or contested
- The claimant needs assistance navigating SIRA's claims process
Independent legal advice ensures claimants understand their rights under the CTP scheme and how to challenge unfair decisions.
Next Steps for Claimants
Time limits and procedural requirements mean chronic pain claims require prompt action. To request contact about your circumstances, complete the quick, no obligation enquiry form.