Dental Injuries and the 2017 CTP Reforms in NSW
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).
Dental injuries sustained in motor accidents involving airbag deployment are now governed by the Motor Accident Injuries Act 2017 (MAIA), which introduced significant changes to how such claims are assessed and compensated in New South Wales. Prior to 1 December 2017, dental injuries were often considered separately from other soft-tissue injuries, with compensation determined on a case-by-case basis. Since the 2017 reforms, dental injuries are assessed under the same framework as other soft-tissue injuries, particularly when they result from impact with an airbag or vehicle interior. This means that a dental injury may now be treated as a threshold injury if it meets the criteria set out in the Motor Accident Guidelines. The reforms have standardised the approach across Greater Sydney and the rest of NSW, reducing variability in outcomes for similar injuries.
How SIRA Assesses Dental Injuries Under the Current Scheme
Under the current NSW CTP scheme administered by the State Insurance Regulatory Authority (SIRA), dental injuries are assessed based on whether they constitute a threshold injury. A threshold injury is defined as a soft-tissue injury that results in a permanent impairment of at least 10% of the whole person, or a more serious injury such as a spinal nerve-root injury with neurological signs. For dental injuries, this means that a claim for damages may only be made if the injury results in a whole person impairment (WPI) of 10% or more, or if it is a more serious injury such as a permanent tooth loss, root fracture, or nerve damage affecting function.
Airbag-related dental injuries are commonly assessed as soft-tissue injuries, particularly if they involve trauma to the gums, jaw, or facial bones. The Motor Accident Guidelines specify that injuries involving the jaw or teeth must be evaluated by a qualified medical practitioner, typically a dental specialist or oral and maxillofacial surgeon, to determine whether there is a permanent impairment. If the injury does not meet the threshold, the claimant may still receive treatment and care benefits, and weekly income payments if they are unable to work, but cannot claim damages for pain and suffering or loss of enjoyment of life.
Practical Steps and Evidence That Matter
If you sustained a dental injury in a motor accident involving an airbag in Greater Sydney, the following steps and evidence are critical to support your claim:
- Seek immediate medical treatment from a dental professional and obtain a written report detailing the nature, cause, and prognosis of the injury.
- Preserve all documentation, including photographs of the injury, dental X-rays, and records of treatment and follow-up appointments.
- Provide a detailed account of the accident to your insurer, including how the airbag deployed and whether you were struck by any part of the vehicle interior.
- Gather witness statements if available, particularly from other occupants or emergency services personnel who may have observed the impact.
- Maintain records of any lost income due to time off work, including payslips and employer letters.
SIRA requires that claims for dental injuries be supported by objective medical evidence. This includes a formal assessment of whole person impairment by an independent medical practitioner approved under the MAIA. Without this assessment, a claim for damages will not progress.
Time Limits and When to Seek Advice
There are time limits that apply to motor accident claims in NSW. You must notify your insurer of a claim within 3 years of the accident date. However, for claims involving a threshold injury, it is essential to begin the process of obtaining a WPI assessment as soon as possible, as delays can impact the validity of the claim. The 52-week rule under the MAIA means that statutory benefits such as weekly payments and treatment and care benefits are generally limited to 52 weeks if the only injuries sustained are threshold injuries. This applies regardless of whether the injury is dental, spinal, or facial.
If your dental injury does not meet the threshold, you may still be eligible for treatment and care benefits and weekly income payments for up to 52 weeks. After this period, further benefits may only be available if you can demonstrate that your injury is more serious than a threshold injury, or if you have a pre-existing condition that was exacerbated by the accident.
A hypothetical example: A driver in Sydney sustained a fractured upper jaw and loss of two front teeth after an airbag deployed during a collision. The injury was assessed by a specialist who confirmed a WPI of 12% due to permanent facial scarring and impaired bite function. Because the WPI exceeds 10%, the claimant is eligible to claim damages under the MAIA. The claim would include compensation for pain and suffering, loss of enjoyment of life, and future care needs.
Next Steps
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.