How NSW CTP Insurers Assess Liability for Dental Injuries
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).
NSW CTP insurers evaluate liability for dental injuries caused by airbag deployment by assessing fault, injury type, and evidence. Under the Motor Accident Injuries Act 2017, claims are based on the accident’s circumstances, not fault. Airbag-related injuries are treated as threshold injuries if they meet the soft-tissue criteria in the Motor Accident Guidelines. Insurers use SIRA’s framework to determine entitlements, including treatment costs and income loss.
Key Factors in Liability Assessment
Insurers consider three main factors: fault, injury type, and evidence. Fault is determined by whether the accident involved a motor vehicle and whether the injury resulted from the accident. For dental injuries, insurers assess if the injury meets the 'threshold injury' definition under the Motor Accident Guidelines. This includes injuries like fractured teeth, jaw trauma, or temporomandibular joint (TMJ) damage. Evidence such as medical records, accident reports, and witness statements are critical to support the claim.
Practical Steps and Evidence for Dental Claims
To strengthen a claim, injured individuals should:
- Preserve medical records detailing the injury and treatment
- Document the accident scene, including airbag deployment details
- Obtain witness statements if available
- Submit a claim form to the at-fault driver’s insurer within the 52-week statutory period
Insurers may request additional evidence, such as a dental specialist’s report confirming the injury’s link to the accident. Failure to provide sufficient evidence may result in a claim being denied or limited.
Time Limits and Dispute Resolution
Claims must be submitted within 52 weeks of the accident if the injury is a 'threshold injury.' After this period, weekly benefits and treatment benefits are generally limited. For non-threshold injuries, insurers assess damages based on the whole-person impairment rating. Disputes can be resolved through the NSW Civil and Administrative Tribunal (NCAT) or by seeking independent medical opinions.
When to Seek Legal Advice
Complex cases, such as those involving multiple injuries or disputes over fault, may require legal assistance. A solicitor can help navigate SIRA’s guidelines, ensure all evidence is submitted, and challenge insurers’ decisions. Legal advice is particularly valuable if the claim is denied or if the injury’s long-term impact is unclear.
Example: Airbag-Related Dental Injury Claim
Consider a scenario where a driver’s airbag deploys forcefully, causing a fractured front tooth and jaw pain. The insurer assesses the injury under the Motor Accident Guidelines, confirming it meets the threshold injury criteria. The claimant receives treatment benefits and weekly income payments for 52 weeks. If the injury is later found to exceed threshold criteria, the claimant may pursue additional compensation through a common law damages claim.
Next Steps
CTP claims depend on the accident date, injury type, and evidence. To request contact about your circumstances, complete the quick, no obligation enquiry form.