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've developed chronic regional pain syndrome (CRPS) following a road trauma in Balmain, understanding your dispute resolution options under NSW's Compulsory Third Party (CTP) scheme is critical. This article explains how SIRA handles CRPS claims, the legal framework governing disputes, and when to seek legal assistance.
How SIRA Handles CRPS Claims
SIRA administers NSW's CTP scheme, which provides statutory benefits for injuries resulting from motor vehicle accidents. CRPS, a neurological condition causing severe pain and sensitivity, may qualify as a 'threshold injury' under the Motor Accident Guidelines. However, SIRA evaluates claims based on clinical evidence, including medical reports confirming the injury's onset and link to the accident.
Under the Motor Accident Injuries Act 2017, benefits like weekly income payments and treatment coverage are available for threshold injuries. However, disputes often arise when claimants believe their CRPS symptoms exceed the 'threshold' or when benefits are denied after 52 weeks. SIRA's internal review process allows for reassessment of claims, but decisions are final unless challenged through the Personal Injury Commission.
Practical Steps for CRPS Claims
To support your CRPS claim, gather: medical records documenting your diagnosis, accident reports, witness statements, and evidence of how the injury impacts your daily life. A specialist neurologist's report is particularly important to establish the neurological basis of your condition.
For example, a Balmain resident who developed CRPS after a car collision may need to demonstrate that their symptoms persist beyond the 52-week period and that the injury meets the 'spinal nerve-root' criteria outlined in the Motor Accident Guidelines. This distinction is crucial, as benefits may transition from statutory support to a common law damages claim if the injury is deemed more severe.
Time Limits and Dispute Options
You have 52 weeks from the accident date to claim weekly benefits for threshold injuries. After this period, SIRA may stop payments unless your claim is reviewed. If you disagree with a decision, you can request an internal review within 28 days. If unresolved, the Personal Injury Commission (PIC) can mediate disputes, though this process is not guaranteed to alter SIRA's decision.
Disputes often hinge on whether your CRPS meets the 'only injuries' threshold. If your claim includes non-threshold injuries, you may have grounds to challenge the 52-week limit. However, legal advice is essential to navigate this process, as SIRA's interpretation of 'threshold injury' is strict.
When to Seek Legal Advice
Consult a solicitor if your CRPS claim is denied, if benefits are cut off after 52 weeks, or if you believe your injury exceeds the threshold. A lawyer can help challenge SIRA's decision, pursue a common law damages claim, or explore options like the PIC's dispute resolution pathway.
Next Steps
CTP dispute resolution for CRPS depends on the accident date, injury severity, and evidence provided. To discuss your circumstances, complete the quick, no obligation enquiry form.