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).
Chronic Regional Pain Syndrome (CRPS) following a road trauma can severely impact an injured person's ability to perform everyday tasks. Under New South Wales' Compulsory Third Party (CTP) scheme, claims for CRPS-related daily living difficulties depend on medical evidence showing a direct link between the road accident and functional limitations. This article explains how NSW CTP laws assess claims for ongoing disability caused by CRPS, the evidence required, and practical steps to take.
How NSW CTP Laws Address CRPS-Related Daily Living Difficulties
Under the Motor Accident Injuries Act 2017 (MAIA), CTP claims for injuries like CRPS must demonstrate a connection between the road accident and the injury. CRPS is classified as a 'threshold injury' under the Motor Accident Guidelines, meaning it qualifies for statutory benefits if it results in functional limitations. However, compensation for ongoing disability depends on a medical assessment showing the injury prevents the person from performing daily activities they could before the accident.
SIRA (State Insurance Regulatory Authority) evaluates claims by considering medical records, treatment history, and evidence of functional capacity loss. For example, if CRPS causes chronic pain that limits mobility or sleep, this may support a claim for weekly income payments or treatment benefits. However, the 52-week statutory benefit period applies only if the injury is the 'only injury' from the accident, as outlined in MAIA s 4.4.
Practical Steps and Evidence for CRPS Claims
To claim compensation for CRPS-related daily living challenges, injured persons must gather specific evidence:
- Medical records showing a diagnosis of CRPS and its impact on daily activities
- Accident reports detailing the trauma's severity
- Witness statements or photographs of the incident
- Evidence of functional limitations, such as difficulty with household tasks, work, or personal care
- Income records to support claims for lost earnings or additional living costs
SIRA requires a 'whole person impairment' assessment to determine if the injury significantly affects the person's ability to live independently. This involves a medical practitioner evaluating whether the CRPS limits the person's capacity to perform essential daily activities compared to before the accident.
Time Limits, Disputes and When to Seek Advice
CTP claims must be submitted within 52 weeks of the accident if the injury is the 'only injury' under MAIA s 4.4. However, if the claim involves multiple injuries or disputes over the injury's impact, time limits may be extended. Injured persons should seek legal advice promptly to ensure all evidence is collected and submitted correctly.
Disputes over CRPS claims often arise when insurers challenge the link between the accident and the injury. In such cases, independent medical opinions or expert testimony may be required to establish the injury's permanence and severity. It is crucial to act quickly, as delays can reduce the chances of securing full compensation for ongoing disability.
Example: How CRPS Impacts Daily Activities
Consider a person who developed CRPS after a car accident, causing persistent pain and swelling in their leg. This limits their ability to walk, sleep, or perform household tasks. Under NSW CTP laws, this would support a claim for weekly income payments and treatment benefits. However, if the injury is deemed the 'only injury' and the person is not permanently disabled, benefits may stop after 52 weeks, even if daily challenges persist.
Next Steps for Injured Persons
If you or a loved one has developed CRPS following a road trauma, it is essential to seek legal advice to understand your options. General information cannot determine whether a claim is available in an individual case. Time limits and procedural requirements may apply. To request contact about your circumstances, complete the quick, no obligation enquiry form.