Understanding insurer decisions for driveway child injuries
When a child is injured as a pedestrian on a driveway, NSW insurers assess claims based on the Motor Accident Injuries Act 2017 and SIRA guidelines. The Central Coast's local insurer practices may vary, but all decisions must comply with state law. Families need to understand what factors insurers consider, how claims are evaluated, and steps to challenge a denial.
Key factors insurers evaluate
Insurers determine claim eligibility by assessing:
- Nature of injury: Whether the child's injuries meet the 'threshold injury' definition under the Motor Accident Injuries Act 2017. This includes soft tissue injuries like whiplash or fractures requiring medical treatment.
- Injury severity: The impact on the child's daily life, such as difficulty walking, school attendance, or emotional distress, must be documented by medical professionals.
- Location and circumstances: Driveways are considered public roads under NSW law, but insurers may scrutinise whether the child was in a 'safe' area or if the incident occurred on private property.
- Fault and contributory negligence: While CTP claims typically don't require proving fault, insurers may consider if the child contributed to the accident (e.g., running into the road).
SIRA's Motor Accident Guidelines clarify that injuries must produce 'neurological signs' or require treatment to qualify. For example, a child with a minor scrape may not meet the threshold, but a sprained ankle requiring medical attention would.
Practical steps for families
To support a claim, families should:
- Document medical evidence: Obtain records from GPs, specialists, or paediatricians confirming the injury's severity and treatment.
- Preserve accident details: Collect witness statements, photos of the driveway, and vehicle registration numbers. Note the time, location, and conditions of the incident.
- Review SIRA's claim forms: Complete the Making a motor accident claim form accurately, explaining how the injury affects the child's life.
- Request a review: If the insurer denies the claim, families can ask for a written explanation and escalate to SIRA or the NSW Civil and Administrative Tribunal (NCAT) within 28 days.
Time limits and dispute options
CTP claims must be submitted within 28 days of the accident. If the insurer denies a claim, families have 28 days to request a review. For disputes beyond this period, legal action may be required, but this is rare for children's injuries.
A hypothetical example: A 7-year-old child is hit by a car while playing on a driveway. The insurer denies the claim, arguing the injury is 'minor.' However, medical records show the child required a week of rest and experienced anxiety, meeting SIRA's threshold criteria. Families can challenge this by providing detailed evidence of the child's recovery and impact.
When to seek legal advice
Families should consult a solicitor if:
- The insurer denies the claim without a clear explanation.
- The child's injuries worsen after the initial assessment.
- The claim is denied after the 28-day review period.
- The family needs help navigating SIRA's complex claim process.
Next steps
CTP claims for driveway injuries depend on the child's medical evidence, the accident's circumstances, and the insurer's interpretation of SIRA guidelines. Families should act quickly to gather documentation and challenge decisions where necessary. For tailored advice, complete the quick, no obligation enquiry form to request contact about your circumstances.