Understanding Dental Injury Claims in NSW Motor Accidents
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 during a motor accident involving an airbag deployment may be covered under the New South Wales Compulsory Third Party (CTP) insurance scheme. If you were injured in a motor vehicle accident on the Central Coast, and your injury involved a tooth, jaw, or related oral structure due to airbag impact, you may be entitled to claim for treatment and care benefits, weekly income payments, or damages depending on the nature and severity of the injury. The Motor Accident Injuries Act 2017 and associated regulations govern these claims, and the State Insurance Regulatory Authority (SIRA) administers the process across NSW, including on the Central Coast.
How SIRA Handles Dental Injury Claims from Airbag Accidents
SIRA applies the same legal framework to dental injuries from airbag deployments as to any other motor accident injury. The CTP insurer must assess whether the injury arose from a motor vehicle accident, and whether it qualifies for benefits under the scheme. A dental injury from an airbag is not automatically excluded. If the injury occurred during a motor accident involving a vehicle registered in NSW, and the injury was caused by the impact or deployment of an airbag, it may be compensable.
The insurer will assess whether the injury is a threshold injury under the Motor Accident Injuries Act 2017. A threshold injury includes certain soft-tissue injuries, including those involving the jaw or facial structures, if they result in a whole person impairment (WPI) of 10% or more. If the injury does not meet the threshold, treatment and care benefits may still be available, but damages for pain and suffering are not payable.
Dispute Resolution Options for Dental Injury Claims
If your claim for dental injury benefits is denied, reduced, or you disagree with the insurer’s assessment of your injury, several dispute resolution options are available under the SIRA framework. These options are designed to provide a fair and timely resolution, particularly for claims on the Central Coast where access to legal advice may vary.
The first step is to request an internal review from the CTP insurer. Insurers must provide a written response within 28 days of receiving a review request. This review must consider all available evidence, including medical reports, dental treatment records, and any documentation of the accident. If the internal review upholds the original decision, you may progress to a formal dispute resolution pathway.
The next option is to apply to the Personal Injury Commission (PIC) for a medical dispute determination. This process is available if there is a disagreement about the nature, extent, or cause of the injury. For dental injuries, this may include disputes over whether the airbag deployment caused the injury, the level of WPI, or the need for ongoing treatment. The PIC will assess medical evidence and may require a second opinion from an independent medical practitioner.
If the PIC decision is not satisfactory, you may apply to the NSW Civil and Administrative Tribunal (NCAT) for a review. NCAT has jurisdiction to hear disputes about CTP claims, including dental injuries, and can determine entitlements to treatment and care benefits, weekly income payments, or damages.
Practical Steps and Evidence That Matter
To support a dental injury claim, you must gather and preserve evidence that demonstrates the injury occurred during a motor accident and was caused by airbag deployment. Key evidence includes:
- A detailed medical record from a dental practitioner or oral surgeon, including diagnosis, treatment plan, and prognosis.
- Photographs of the injury, dental work, or facial trauma taken shortly after the accident.
- A statement from a medical practitioner confirming the injury was caused by the accident, particularly if the airbag deployed.
- A copy of the police accident report, if one was filed, or a motor vehicle accident report (MVAC) completed at the scene.
- Witness statements, if available, describing the airbag deployment and the impact on the face or mouth.
- Records of dental treatment, including invoices, referrals, and progress notes.
If you were not wearing a seatbelt, or were not in a position to avoid contact with the airbag, this may be relevant to the insurer’s assessment of fault and causation. However, CTP claims are not based on fault, so the absence of a seatbelt does not bar a claim, but may affect the insurer’s assessment of the injury’s severity.
Time Limits and When to Seek Advice
There are time limits that apply to CTP claims in NSW. You must notify your insurer of a claim within 6 months of the accident, or within 6 months of becoming aware of the injury, whichever is later. Failure to notify within this period may result in a claim being barred.
If you are disputing a decision, you must apply to the Personal Injury Commission within 12 months of the insurer’s decision, or within 12 months of the date you became aware of the decision, whichever is later. These time limits are strict and must be met to preserve your rights.
A hypothetical example: A driver on the Central Coast was involved in a head-on collision in January 2025. The airbag deployed and struck the driver’s face, resulting in a fractured jaw and multiple tooth losses. The CTP insurer initially refused to pay for a dental implant, claiming the injury was not caused by the accident. The driver obtained a second opinion from a maxillofacial surgeon, who confirmed the injury was consistent with airbag impact. The driver requested an internal review, which was denied. The driver then applied to the Personal Injury Commission, which ordered the insurer to fund the treatment. The process took 10 months.
When to Seek Independent Advice
Disputes over dental injuries, particularly those involving airbag deployment, can be complex due to the need to establish causation and the long-term nature of some dental treatments. If you are unsure about the insurer’s assessment, or if you believe the decision is incorrect, it is advisable to seek independent legal or medical advice before proceeding with a formal dispute.
The dispute resolution process does not guarantee a change in decision. The insurer may maintain its position, and the PIC or NCAT may uphold the original decision. However, a formal review provides a structured and legally recognised pathway to challenge a decision.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.