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 is a complex injury that can significantly impact a person's quality of life. In New South Wales, the Personal Injury Commission (PIC) assesses CRPS claims under the Motor Accident Injuries Act 2017 and the Motor Accident Guidelines. This article explains how the PIC evaluates CRPS claims, what evidence is required, and how disputes are resolved in Armidale.
How the PIC Assesses CRPS Claims
The PIC evaluates CRPS claims based on medical evidence and the Motor Accident Guidelines. CRPS is classified as a 'threshold injury' under NSW CTP law, meaning it qualifies for statutory benefits like weekly income payments and treatment and care benefits. However, the PIC requires clear documentation linking the injury to the road trauma. Medical records must show:
- A diagnosis of CRPS by a registered medical practitioner
- Clinical signs such as prolonged pain, temperature changes, or skin sensitivity
- A connection between the injury and the accident
The PIC may also consider the severity of the pain and its impact on daily activities. For example, if a claimant experiences sleep disturbances or difficulty working due to CRPS, this may influence the level of compensation.
Evidence Required for CRPS Claims
To support a CRPS claim, claimants must provide:
- Medical records from a specialist, including imaging reports and treatment notes
- A detailed accident report from the NSW Police or the driver’s insurance company
- Witness statements or photographs of the incident
- Income records to demonstrate lost earnings
- A letter from the treating doctor confirming the injury meets the Motor Accident Guidelines
In disputes, the PIC may request additional evidence, such as a second opinion from a medical expert. Claimants should ensure all documentation is complete and directly relates to the CRPS diagnosis.
Resolving Disputes Over CRPS Compensation
If the PIC disputes a CRPS claim, claimants can request an internal review or seek an independent medical assessment. The PIC’s process for reviewing decisions includes:
- Internal Review: The PIC may reassess the claim based on new evidence or a different interpretation of existing records.
- Medical Dispute Pathway: If the claimant disagrees with the PIC’s decision, they can apply for an independent medical review through the NSW Department of Communities and Justice. This process involves a specialist assessing the claimant’s condition and providing a recommendation.
- Legal Challenge: In rare cases, claimants may pursue a legal challenge, but this requires a solicitor to demonstrate that the PIC’s decision was legally incorrect.
It’s important to note that a dispute does not guarantee a changed decision. The PIC’s assessments are based on the evidence provided, and claimants must ensure their case is supported by robust documentation.
Practical Steps for Claimants in Armidale
Claimants in Armidale should take the following steps to strengthen their CRPS claim:
- Seek immediate medical attention to document the injury
- Report the accident to the police and obtain a copy of the report
- Contact the at-fault driver’s insurance company to initiate the claim
- Keep a diary of symptoms, pain levels, and how the injury affects daily activities
- Consult a solicitor if the PIC disputes the claim or if the compensation offer is unsatisfactory
Time Limits and Next Steps
NSW CTP claims must be submitted within 52 weeks of the accident for certain benefits, such as weekly income payments. However, claims for treatment and care benefits can be made at any time. If a claimant disagrees with the PIC’s decision, they should act quickly to request a review or independent assessment.
When to Seek Legal Advice
If the PIC denies a CRPS claim or offers an unsatisfactory compensation amount, claimants should seek legal advice. A solicitor can help challenge the decision, negotiate a better outcome, or pursue a legal remedy. Legal advice is particularly important if the claimant believes the PIC’s assessment was incorrect or if there are disputes over the severity of the injury.
Final Steps
CTP claims involving CRPS can be complex, especially when disputes arise. The PIC’s assessment depends on the quality of evidence provided, and claimants must ensure they meet all requirements. For personalized advice tailored to your circumstances, complete the quick, no obligation enquiry form to request contact about your claim.