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 your insurer is delaying a decision on your NSW Compulsory Third Party (CTP) injury claim, proper documentation is critical to protect your entitlements. Under the Motor Accident Injuries Act 2017, insurers must respond to claims within specific timeframes, but delays are common. This article explains what records to gather, how to handle delays, and when to seek legal advice.
Why Documentation Matters for Delayed Claims
Insurers may delay decisions to reassess claims or request additional evidence. Under SIRA guidelines, you must provide sufficient documentation to support your claim. Key records include:
- Medical records showing injury diagnosis and treatment
- Accident reports from police or witnesses
- Witness statements detailing the incident
- Income records to prove lost earnings
- Correspondence with the insurer showing communication history
Documenting these elements helps establish the injury's connection to the accident and supports your claim under the CTP scheme.
Time Limits and Dispute Options
The Motor Accident Injuries Act 2017 sets strict deadlines for insurers to respond. If your claim is delayed beyond 52 weeks, weekly benefits may be limited to threshold injuries, as outlined in s 4.4. If an insurer fails to act within these timeframes, you may:
- Request a written explanation for the delay
- Submit additional evidence to support your claim
- Escalate the matter to SIRA's dispute resolution process
Note: Time limits apply to claims under the current scheme. Accidents before 1 December 2017 fall under the former Motor Accidents Compensation Act 1999.
Practical Example: Documenting a Delayed Claim
Consider a scenario where a pedestrian in Sydney suffers soft-tissue injuries after a car accident. The insurer delays responding for 6 weeks, during which the claimant continues treatment. Proper documentation would include:
- Hospital records showing the injury's progression
- A GP report linking the injury to the accident
- Photos of the accident scene
- A witness statement confirming the incident
This evidence helps demonstrate that the injury meets the threshold injury definition under the Motor Accident Guidelines.
When to Seek Legal Advice
If your insurer refuses to pay, disputes the injury's severity, or fails to respond within the required timeframe, legal advice may be necessary. A solicitor can help:
- Review your claim for compliance with SIRA requirements
- Challenge unreasonable delays or denials
- Navigate the dispute resolution process
Time limits and procedural rules vary depending on the accident date and claim history. For personalized guidance, complete the quick, no obligation enquiry form.