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 Newcastle or the Hunter region, understanding how the NSW CTP scheme addresses your treatment and rehabilitation needs is critical. This article explains how SIRA evaluates CRPS-related claims, what evidence is required to support your case, and the legal boundaries under the Motor Accident Injuries Act 2017.
How CRPS Treatment and Rehabilitation Plans Are Assessed
Under the NSW CTP scheme, treatment and rehabilitation planning for CRPS must align with the Motor Accident Guidelines. SIRA assesses whether your treatment plan meets the 'reasonably necessary' standard, which requires a medical practitioner to document that the proposed care is:
- Directly related to your injury
- Evidence-based
- Cost-effective
- Likely to improve your functional capacity
For example, a physiotherapist's plan to address joint stiffness and muscle atrophy would need to include specific exercises, frequency, and expected outcomes. SIRA may request additional assessments if the treatment plan appears inconsistent with standard medical practice.
Evidence Required for CRPS Rehabilitation Planning
To support your claim, you must provide:
- Detailed medical records showing a diagnosis of CRPS (using the ICD-10 code G99.3)
- A treatment plan from your specialist outlining:
- Specific therapies (e.g., desensitization, mirror therapy)
- Expected duration of treatment
- How the plan addresses your pain and functional limitations
- Evidence of how your injury impacts daily activities (e.g., work capacity, mobility)
- Any correspondence with your treating doctor confirming the treatment plan's necessity
SIRA may also require a report from a rehabilitation specialist if your case involves complex needs.
Time Limits and Dispute Resolution
If your injury is classified as a 'threshold injury' under the Motor Accident Injuries Act 2017, weekly benefits and treatment payments may be limited after 52 weeks. This applies only if your injury does not meet the whole person impairment threshold. For non-threshold injuries, there is no automatic time limit, but SIRA may review your claim if it appears the injury has stabilized.
Disputes over treatment planning typically involve a 'review of claim' under section 129 of the Motor Accident Injuries Act 2017. You may need to provide additional evidence, such as a second opinion from a specialist, to challenge SIRA's decision.
When to Seek Legal Advice
If your treatment plan is rejected, or if you believe your rehabilitation needs are not being fully addressed, consider consulting a solicitor. A lawyer can help:
- Challenge SIRA's assessment of your treatment plan
- Request a review of your claim
- Explore options for additional support if your injury worsens
Remember, the legal rules governing your claim may change depending on the date of your accident. Always verify whether the current scheme applies to your circumstances.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.