Chronic regional pain syndrome (CRPS) following a motor vehicle accident in New South Wales is assessed under the Motor Accident Injuries Act 2017 and the Motor Accident Injuries Regulation 2017. Insurers in Bathurst and across NSW evaluate claims based on medical evidence, the nature of the injury, and whether the condition meets the legal threshold for compensation. A claim for CRPS may be supported by treatment and care benefits, weekly income payments, or damages if the injury exceeds the threshold for serious injury. However, insurers apply strict criteria to determine eligibility, particularly where the injury is not immediately apparent or involves complex neurological symptoms.
The Motor Accident Injuries Act 2017 establishes that compensation for motor accident injuries is available only if the injury is serious or if it meets the threshold for a serious injury. For CRPS, this means the injury must be more than a minor soft tissue injury. The Act defines a serious injury as one that causes a permanent impairment of at least 15% of the whole person, or that results in a permanent loss of function or a long-term condition that significantly affects daily life. Insurers assess whether CRPS constitutes a serious injury by reviewing medical evidence, including imaging, nerve conduction studies, and specialist assessments.
SIRA’s Motor Accident Guidelines provide that CRPS may be considered a serious injury if it results in a permanent impairment of at least 15% of the whole person, or if it causes significant and long-term functional limitations. Insurers in Bathurst rely on these guidelines to determine whether a claim for CRPS qualifies for damages. A diagnosis of CRPS alone is not sufficient; there must be objective medical evidence showing that the condition has caused lasting impairment, not just pain. Insurers may require a formal assessment by a qualified medical practitioner, such as a pain specialist or neurologist, to verify the diagnosis and assess the degree of impairment.
To support a claim, claimants must provide comprehensive medical evidence, including:
- A diagnosis of CRPS from a medical practitioner with relevant expertise
- Documentation of treatment and care, including physical therapy, medication, and psychological support
- Evidence of functional limitations, such as reduced mobility, inability to work, or loss of daily activities
- A whole person impairment (WPI) assessment conducted by an independent medical assessor
- Records of ongoing symptoms and treatment over time, particularly if symptoms have persisted beyond 12 months
Insurers may dispute claims where the medical evidence is inconsistent, where the injury is not linked to the accident, or where the claimant has a pre-existing condition that may have contributed to the development of CRPS. In such cases, insurers may request a second opinion or a review by an independent medical assessor. Claimants in Bathurst should preserve all medical records, accident reports, and correspondence with insurers, as these may be critical in supporting a claim or challenging a decision.
A common issue in CRPS claims is the timing of diagnosis. Insurers may argue that symptoms did not begin until months after the accident, which could affect the claim’s validity. However, the law allows for delayed onset of symptoms, provided there is a clear link between the accident and the development of CRPS. Claimants must demonstrate that the accident was a significant contributing factor to the condition, not merely a background event.
If an insurer refuses a claim or offers a settlement that does not reflect the full impact of CRPS, the claimant may seek a review. The Motor Accident Injuries Act 2017 provides a formal process for disputing decisions, including the right to apply to the Civil and Administrative Tribunal (NCAT) for a determination. In Bathurst, claimants may also seek assistance from a legal practitioner or a claims support organisation to help navigate the process.
A hypothetical example: A 42-year-old woman in Bathurst was involved in a rear-end collision in February 2025. She initially experienced mild pain in her left leg, but over the next 10 months, the pain intensified and spread to her foot, accompanied by swelling, skin changes, and loss of movement. She was diagnosed with CRPS type 1 in December 2025 by a specialist. Her WPI was assessed at 22% due to permanent loss of function in her lower limb. The insurer initially refused to pay damages, arguing that the injury was not serious enough. After a review and submission of additional medical evidence, including a specialist report and treatment logs, the insurer agreed to a settlement that included weekly payments and a lump sum for damages.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.