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).
Complex regional pain syndrome (CRPS) following a motor vehicle accident in New South Wales requires thorough and ongoing medical documentation to support a claim for compensation under the Compulsory Third Party (CTP) insurance scheme. This condition, characterised by severe, prolonged pain, swelling, and changes in skin colour or temperature, often develops after trauma and can significantly impact daily life. Under the Motor Accident Injuries Act 2017, individuals with CRPS may be entitled to treatment and care benefits, weekly income payments, and, if the injury meets the legal threshold, damages. However, eligibility depends on the nature and duration of symptoms, and the evidence must clearly demonstrate the link between the accident and the development of CRPS.
The Motor Accident Injuries Act 2017 and the associated Motor Accident Guidelines set out the framework for assessing claims involving chronic pain conditions like CRPS. Unlike injuries that resolve within a few weeks, CRPS is considered a long-term or permanent condition in many cases. To qualify for benefits, the injury must be assessed as a threshold injury under the Act, which includes conditions that cause significant and lasting impairment. The Guidelines clarify that a diagnosis of CRPS alone is not sufficient; there must be objective clinical evidence showing that the condition has caused or is likely to cause a permanent impairment of at least 10% of the whole person, and that it has not resolved within 52 weeks of the accident.
The most critical documentation for a CRPS claim includes a formal diagnosis from a medical practitioner, preferably a pain specialist or neurologist, supported by imaging and nerve conduction studies. The medical record must detail the onset of symptoms, their progression, and how they affect function. This includes records of physical therapy, medication use, and any interventions such as nerve blocks or spinal cord stimulation. Photographs of skin changes, swelling, or altered limb function taken over time can also serve as useful evidence. Witnesses to the accident, particularly those who observed changes in mobility or behaviour shortly after the incident, may provide corroborative evidence.
A common mistake is relying solely on self-reported pain levels. While patient-reported outcomes are valuable, the CTP scheme requires objective medical evidence to assess the severity and permanence of the injury. Medical practitioners must complete a whole person impairment (WPI) assessment using the Australian Medical Association’s impairment rating guidelines. This assessment is used to determine whether the injury meets the 10% threshold for damages. If the WPI is below 10%, only treatment and care benefits and weekly income payments may be available, and these are generally limited to 52 weeks unless the injury is deemed to be a permanent or long-term condition.
In Greater Sydney, as elsewhere in NSW, claims are processed by the State Insurance Regulatory Authority (SIRA), which oversees the CTP scheme. It is essential to notify the insurer as soon as possible after the accident, and to keep a copy of all correspondence. Delays in reporting or submitting evidence can affect the outcome. If the insurer disputes the diagnosis or the extent of impairment, a review or dispute resolution process is available through SIRA. However, the burden of proof lies with the claimant to demonstrate that the injury arose from the accident and that it meets the legal criteria for benefits.
A hypothetical example: A 38-year-old cyclist in Sydney was struck by a car in a car park in July 2024. Following the accident, they developed severe burning pain in the left foot, swelling, and difficulty walking. Over the next 18 months, they underwent multiple specialist assessments, MRI scans, and a WPI assessment that confirmed a 12% impairment due to CRPS. The medical evidence, including treatment logs and photographs, was submitted to the insurer. Because the injury persisted beyond 52 weeks and met the threshold, the claim was approved for damages in addition to treatment and care benefits.
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