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 on the Central Coast, avoiding common mistakes in your CTP claim is critical. NSW CTP insurers assess CRPS claims under the Motor Accident Injuries Act 2017 and SIRA guidelines, which require specific evidence to support your claim. This article explains the key errors to avoid, how insurers evaluate CRPS claims, and the practical steps to strengthen your case.
How NSW CTP Insurers Assess CRPS Claims
CRPS is a complex condition that requires medical evidence to prove its link to your road trauma. SIRA guidelines state that claims must demonstrate a 'threshold injury', meaning the injury must be serious enough to qualify under the Motor Accident Guidelines. Insurers will scrutinise medical records to confirm:
- A clear connection between your road trauma and CRPS symptoms
- Documentation of neurological signs, such as abnormal reflexes or sensory changes
- Evidence of ongoing pain that impacts daily activities
A common mistake is failing to establish this medical link. For example, if your GP only notes 'chronic pain' without specifying CRPS, insurers may reject the claim. Always ensure your medical team uses the correct diagnosis and records detailed symptom progression.
Common Mistakes to Avoid
- Delaying Medical Attention: CRPS symptoms often worsen over time, so delays in seeking treatment can weaken your claim. SIRA guidelines require prompt medical evaluation to establish the injury's timeline.
- Not Documenting Symptoms: Keep a daily journal of your pain levels, sleep disturbances, and mobility issues. Insurers may challenge claims where symptoms are not consistently recorded.
- Ignoring SIRA's 'Only Injuries' Rule: If your CRPS is the only injury from the accident, weekly benefits and treatment payments may stop after 52 weeks under s 4.4 of the Motor Accident Injuries Act 2017. This applies even if your condition is ongoing.
- Failing to Report the Accident Promptly: Delays in notifying your insurer can lead to disputes over claim validity. SIRA requires claims to be reported within a reasonable time, typically within 28 days of the accident.
- Not Seeking Independent Medical Advice: Insurers may request a second opinion to assess your CRPS diagnosis. Refusing this could result in claim denial.
Critical Evidence for CRPS Claims
To avoid rejection, gather the following:
- Medical Records: Include specialist reports, MRI scans, and notes from neurologists or pain management experts.
- Accident Reports: Obtain a police report or statement from the driver involved.
- Witness Statements: Eyewitness accounts of the accident's severity can support your claim.
- Income Records: Document lost wages or reduced earning capacity due to CRPS.
- Insurer Correspondence: Keep copies of all communications with your CTP insurer.
When to Seek Legal Advice
If your claim is denied or you're unsure about your options, consult a solicitor specialising in NSW CTP claims. They can:
- Challenge incorrect medical assessments
- Navigate SIRA's complex guidelines
- Ensure you meet all statutory deadlines
Next Steps
CTP claims for CRPS require careful attention to both medical and legal details. By avoiding these common mistakes and gathering strong evidence, you can improve your chances of securing compensation. For personalised guidance, complete the quick, no obligation enquiry form to request contact about your circumstances.