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).
Insurers assessing liability for NSW Compulsory Third Party (CTP) claims in regional areas evaluate factors such as fault, injury type, and evidence availability. Delays in decisions can affect claim outcomes, but claimants can take steps to challenge or expedite assessments. This article explains the legal framework, practical considerations, and time limits relevant to regional CTP claims.
Legal Framework for Liability Assessments
NSW CTP insurers assess liability under the Motor Accident Injuries Act 2017 and SIRA guidelines. Liability is determined by whether the accident involved a motor vehicle and whether the injured person meets the 'threshold injury' criteria. SIRA outlines that insurers must evaluate claims based on medical evidence, accident reports, and witness statements. In regional areas, insurers may take longer to assess claims due to limited access to medical records or specialist assessments.
Practical Steps for Claimants
Claimants should gather evidence such as medical records, accident reports, and witness details. For regional claims, it is crucial to document the location of the accident and any delays in accessing medical care. SIRA advises that claimants notify insurers promptly and request written confirmation of any delays. If an insurer fails to respond within 52 weeks for threshold injuries, claimants may need to escalate the matter.
Time Limits and Dispute Options
Under the Motor Accident Injuries Act 2017, weekly benefits for threshold injuries are generally limited to 52 weeks. Delays in insurer decisions may affect eligibility for ongoing payments. Claimants can dispute delays by contacting SIRA or seeking mediation through the NSW Civil and Administrative Tribunal (NCAT). If an insurer refuses to pay, claimants should review the reasons and consider legal advice if necessary.
Example of Regional Liability Assessment
Consider a pedestrian injured in a car park in a regional town. The insurer may delay assessing liability if medical records are incomplete or if there is no immediate access to a specialist. In such cases, claimants should request a detailed timeline from the insurer and ensure all evidence is submitted promptly. SIRA guidelines emphasize that insurers must act reasonably and provide clear reasons for delays.
When to Seek Legal Advice
Claimants should seek legal advice if insurers refuse to pay, delay decisions beyond 52 weeks, or dispute liability without valid reasons. A solicitor can help challenge delays, review evidence, and ensure claimants meet all legal requirements. Time limits for disputes vary, so acting early is essential.
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