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).
If you suffered dental injuries in a motor accident caused by an airbag deploying in Bathurst, NSW, understanding how insurers assess liability is critical. Under the NSW Compulsory Third Party (CTP) scheme, insurers evaluate claims based on fault, injury causation, and evidence. This article explains how dental injuries are assessed, what evidence matters, and how to navigate potential disputes.
How NSW CTP Insurers Evaluate Liability
NSW CTP insurers assess liability by determining whether the accident involved a motor vehicle and whether the injury was caused by the accident. For dental injuries from airbags, insurers will examine:
- Fault: Whether the accident involved a motor vehicle. Airbag deployment in a car accident typically satisfies this, but insurers may question if the injury resulted from a non-motor vehicle incident (e.g., a car park collision).
- Causation: Medical evidence must link the dental injury to the airbag deployment. For example, a fractured tooth or jaw injury caused by an airbag’s force must be documented in medical records. SIRA guidelines emphasize that injuries must be 'caused by the accident' to qualify for benefits.
- Threshold injury status: If the injury is classified as a 'threshold injury' (e.g., soft tissue damage), insurers apply the 52-week statutory benefit limit. Severe dental injuries, like missing teeth or jaw fractures, may exceed this threshold and qualify for longer benefits or damages.
Evidence Required for Dental Injury Claims
To support a dental injury claim, you must provide:
- Medical records: Detailed reports from a dentist or medical practitioner confirming the injury’s cause and severity. For example, a report stating the tooth was 'knocked out' by an airbag would be critical.
- Accident report: Police or insurer documentation showing the airbag deployed and the circumstances of the collision. This helps establish the injury’s connection to the accident.
- Witness statements: Accounts from others at the scene, such as other drivers or passengers, can corroborate the airbag’s role in causing the injury.
- Photographs: Images of the damaged vehicle, airbag deployment, and the injured area may support the claim.
Time Limits and Dispute Resolution
CTP claims must be submitted within 52 weeks of the accident for benefits. If the injury is a threshold injury, benefits stop after 52 weeks unless the claimant seeks further legal action. For non-threshold injuries, such as severe dental damage requiring surgery, the 52-week limit does not apply, and the claimant may pursue damages.
If the insurer disputes liability, you may need to:
- Request a review: SIRA allows claims to be reviewed by an independent assessor. This process evaluates whether the injury meets the threshold or qualifies for damages.
- Seek legal advice: A solicitor can help challenge an insurer’s decision, especially if the claimant believes the injury was not properly assessed.
Hypothetical Example
Imagine a passenger in Bathurst who suffered a fractured jaw after an airbag deployed during a collision. The insurer would:
- Review medical records confirming the jaw injury was caused by the airbag.
- Check the accident report to confirm the airbag was activated.
- Determine if the injury exceeds the threshold (e.g., requiring surgery or long-term dental care).
- Decide whether to pay benefits under the CTP scheme or refer the claim to the NSW Civil and Administrative Tribunal (NCAT) for damages.
When to Seek Advice
If your dental injury involves complex treatment, long-term care, or disputes over liability, consult a solicitor. The CTP scheme has strict rules, and insurers may not always agree on the severity or cause of injuries. An experienced lawyer can help ensure you receive the correct benefits or pursue damages.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.