Where a person's only injuries resulting from the accident are threshold injuries, weekly benefits and treatment and care generally cease after 52 weeks (ss 3.11 and 3.28).
Dental injuries caused by airbag deployment in a motor vehicle accident may entitle injured persons to compensation under NSW's Compulsory Third Party (CTP) scheme. Caregivers and families in rural and remote areas face unique challenges when navigating claims for dental injuries, including access to specialists, treatment coordination, and meeting statutory deadlines. This article explains how SIRA's guidelines apply to such claims and outlines practical steps for families to pursue compensation.
SIRA Guidelines for Dental Injuries
Under the Motor Accident Injuries Act 2017, dental injuries are classified as 'threshold injuries' if they meet specific clinical criteria. SIRA's guidelines state that injuries such as fractured teeth, jaw trauma, or temporomandibular joint (TMJ) damage may qualify for treatment and income support if they result from a motor accident. However, claims for dental injuries are limited to 52 weeks unless the injury meets the 'whole person impairment' threshold, which requires a medical practitioner to confirm lasting functional loss.
Caregivers must ensure injured persons receive timely medical attention to document the injury's severity. For example, a fractured front tooth with pulp exposure may qualify for treatment benefits, while a minor chip without clinical signs may not. SIRA emphasizes that evidence of treatment, such as dental records or a specialist's report, is critical to support claims.
Rural and Remote Challenges
Families in rural NSW may struggle to access dental specialists or trauma services, delaying diagnosis and claim processing. Transport costs, limited clinic availability, and communication barriers can complicate securing medical evidence. SIRA requires claims to be supported by 'objective clinical evidence, ' which may be harder to obtain in remote areas. Caregivers should coordinate with local GPs or telehealth services to document the injury's impact on daily activities, such as eating or speaking.
Practical Steps for Families
- Seek immediate medical attention: Visit a dentist or hospital to assess the injury and obtain records. A dental X-ray or specialist opinion may be needed to prove the injury's connection to the accident.
- Document treatment costs: Keep receipts for dental procedures, medications, and travel expenses related to care.
- Notify the at-fault driver's insurer: SIRA requires claims to be submitted to the insurer within 52 weeks of the accident. Delays may jeopardize treatment benefits.
- Coordinate with caregivers: If the injured person requires assistance, ensure all medical and financial records are shared with the insurer and SIRA.
Disputes and Time Limits
If the insurer disputes the claim, families may need to request a review under the Motor Accident Injuries Regulation 2017. SIRA allows for a 28-day period to challenge a decision, but this may vary depending on the claim's complexity. Time limits are strict: treatment benefits generally stop after 52 weeks unless the injury meets the whole person impairment threshold. Families should act quickly to secure evidence and avoid missing deadlines.
When to Seek Legal Advice
Caregivers should consult a solicitor if the insurer rejects the claim, disputes the injury's severity, or delays processing. A lawyer can help challenge decisions, negotiate for additional compensation, or explore options like the NSW Civil and Administrative Tribunal (NCAT) for disputes.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.