Children injured as pedestrians in driveways or low-speed vehicle areas may face long-term recovery challenges. Under NSW Compulsory Third Party (CTP) laws, insurers assess functional recovery and daily activity limitations through specific medical and evidentiary standards. This article explains how SIRA evaluates claims for children's injuries, the evidence required to support recovery timelines, and how insurers handle long-term mobility or activity restrictions.
How SIRA Evaluates Functional Recovery
The NSW State Insurance Regulatory Authority (SIRA) assesses a child's ability to return to daily activities by applying the Motor Accident Guidelines. These guidelines require medical professionals to evaluate both physical and functional impairments. For example, if a child has mobility limitations due to a spinal nerve-root injury, the insurer will consider whether the injury meets the 'threshold injury' criteria under the Motor Accident Injuries Act 2017. This involves documenting neurological signs, such as reduced reflexes or muscle weakness, and correlating these with the child's ability to perform routine tasks like walking to school or playing sports.
A critical distinction is made between 'threshold injuries', which typically involve soft tissue damage or minor fractures, and more severe impairments that affect long-term mobility. SIRA requires detailed medical records, including assessments from paediatricians, physiotherapists, and occupational therapists, to determine whether a child's functional recovery aligns with the injury's severity.
Evidence Needed for Daily Activity Claims
To support claims about a child's functional recovery, families must provide specific evidence. This includes:
- Medical records detailing the injury's impact on mobility, such as gait analysis or wheelchair prescriptions
- School reports or activity logs showing changes in the child's ability to participate in daily routines
- Therapist notes outlining progress toward recovery milestones
- Statements from teachers or caregivers describing functional limitations
For example, if a child requires a wheelchair for 50% of school days due to a spinal injury, this must be documented by a medical professional and linked to the accident's cause. SIRA also considers the child's pre-accident activity level to assess the injury's effect on their quality of life.
Insurer Considerations for Long-Term Cases
CTP insurers must distinguish between short-term 'threshold injuries' and long-term impairments that affect daily activities. Under the Motor Accident Injuries Act 2017, weekly benefits and treatment payments generally stop after 52 weeks if the injury is classified as a threshold injury. However, if the child's mobility or function is significantly impaired, the insurer may extend benefits or provide additional compensation for long-term care needs.
Insurers also evaluate whether the child's injury meets the 'whole person impairment' threshold, which requires a specialist to assess the injury's impact on all aspects of the child's life. This process involves comparing the child's current functional capacity to their pre-accident abilities and determining whether the injury has caused permanent or prolonged disability.
Practical Steps for Families in Bankstown
Families should take the following steps to support a CTP claim:
- Seek immediate medical attention to document the injury's impact on daily activities
- Keep a detailed log of the child's mobility, such as how far they can walk or whether they need assistance with tasks
- Obtain written statements from teachers, therapists, or caregivers about changes in the child's routine
- Ensure all medical records clearly link the injury to the accident
If the child's recovery extends beyond 52 weeks or involves long-term mobility issues, families should request a formal assessment from a SIRA-approved medical expert. This helps establish whether the injury meets the criteria for ongoing benefits or additional compensation.
When to Seek Legal Advice
While SIRA provides clear guidelines, interpreting these rules can be complex. Families should consult a legal professional if:
- The child's injury is unclear or involves multiple medical opinions
- The insurer disputes the injury's classification as a threshold injury
- The child requires long-term care or mobility assistance
Legal experts can help ensure that all evidence is properly presented and that the family understands their rights under NSW CTP laws. Every claim depends on its own facts, and the outcome will vary based on the specific circumstances of the injury and recovery.
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