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 CTP insurers assess an injured person's ability to return to daily activities by examining medical evidence, functional capacity, and adherence to SIRA guidelines. This article explains the practical process insurers use to evaluate claims involving daily activity limitations, focusing on the legal framework and evidence required for claims in Auburn. Understanding how these assessments work can help injured persons prepare their case effectively.
Key Factors in Daily Activity Capacity Assessments
NSW CTP insurers evaluate whether an injury limits a person's ability to perform everyday tasks such as cooking, cleaning, or managing personal care. This assessment is based on the Motor Accident Injuries Act 2017 and SIRA guidelines, which require insurers to consider:
- Medical evidence: Detailed reports from doctors confirming the injury’s impact on daily activities. For example, if a back injury prevents someone from lifting groceries, the report must explicitly link the injury to this limitation.
- Functional capacity: Insurers assess whether the injury affects the person’s ability to work, exercise, or manage household responsibilities. This includes evaluating pain levels, mobility, and endurance.
- SIRA’s role: SIRA’s
- Motor Accident Claims* page states that insurers must apply the
- Guidelines for the Assessment of Impairment* to determine if the injury meets the threshold for compensation. For instance, a soft-tissue injury (like a whiplash) that prevents someone from driving for six weeks would be considered under these guidelines.
Evidence Needed to Support Daily Activity Claims
To substantiate a claim for daily activity limitations, injured persons should gather:
- Medical records: Include diagnoses, treatment plans, and notes from consultations. A doctor’s statement confirming that the injury prevents specific activities (e.g., 'Unable to lift objects heavier than 5kg for 12 weeks') is critical.
- Activity logs: Document how the injury affects daily routines. For example, noting that cooking takes twice as long due to hand pain.
- Witness statements: Testimonies from family or colleagues about changes in the person’s ability to perform tasks.
- Occupational assessments: If the injury impacts work, a report from a vocational expert may be required to show how daily activities are affected.
Time Limits and Dispute Options
NSW CTP claims must be submitted within 52 weeks of the accident if the injury is classified as a 'threshold injury' (per s 4.4 of the Motor Accident Injuries Act 2017). After this period, weekly benefits and treatment payments typically stop unless the injury is severe enough to qualify for long-term compensation. If an insurer disputes the assessment, claimants can request a review by the Motor Accident Claims Tribunal or seek independent medical opinions to challenge the insurer’s findings.
When to Seek Legal Advice
While some claims can be resolved through the CTP insurer’s process, complex cases, such as those involving lifetime care needs, interstate accidents, or overlapping workers’ compensation claims, may require legal assistance. A solicitor can help ensure all evidence is properly submitted and that the claimant understands their rights under the Motor Accident Injuries Act 2017.
Example Scenario
Consider a person who suffered a knee injury in a car accident in Auburn. Their doctor notes they cannot climb stairs or walk for prolonged periods. The insurer assesses whether this limits their ability to perform daily tasks like grocery shopping or housework. If the injury meets the threshold for compensation under SIRA guidelines, the claimant may be eligible for treatment benefits and income support.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.