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).
When a child is injured in a driveway under NSW CTP laws, insurers assess claims based on specific criteria. The Personal Injury Commission (PIC) evaluates evidence, injury severity, and compliance with SIRA guidelines. This article explains what insurers typically expect in disputes, how child injuries are assessed differently from standard claims, and practical steps to strengthen a claim.
Key factors insurers consider in driveway child claims
Insurers focus on three main areas: the nature of the injury, evidence of the incident, and adherence to SIRA's child injury protocols. For driveway accidents, the PIC often requires:
- Medical evidence showing a threshold injury (as defined in the Motor Accident Injuries Act 2017). This includes clinical notes confirming neurological signs or spinal nerve-root injuries.
- Accident details such as vehicle speed, location, and whether the child was on private property. SIRA guidelines note that low-speed impacts (under 30 km/h) may influence benefit calculations.
- Witness statements or CCTV footage to establish fault or contributory negligence, as children's ability to account for events may be questioned.
How SIRA's approach differs for child injuries
SIRA's Motor Accident Guidelines treat child injuries with distinct criteria. For example, a soft-tissue injury with spinal nerve-root involvement may qualify for benefits even without radiculopathy symptoms. Insurers also consider:
- Developmental factors - a child's age and maturity may affect how injuries are assessed.
- Long-term impact - SIRA emphasizes the potential for future complications in young claimants.
- Specialist reports - Paediatricians or neurologists may be required to confirm injury severity.
A hypothetical example: A 6-year-old struck by a car while playing in a driveway. The PIC may require a medical report confirming a spinal nerve-root injury, even if the child shows no radiculopathy symptoms. The claimant must also prove the incident occurred on private property, as CTP coverage may not apply to certain locations.
Common disputes and resolution steps
Disputes often arise over:
- Threshold injury classification - Insurers may challenge whether an injury meets the 52-week benefit limit. If a child's only injuries are threshold injuries, weekly payments typically stop after 52 weeks.
- Fault allocation - The PIC may dispute whether the driver was blameless. For example, if the child ran into the road, contributory fault could reduce compensation.
- Evidence adequacy - Insurers may request additional documentation, such as school records or witness statements.
To resolve disputes, claimants should:
- Request a review through the PIC's internal process, which allows for medical expert assessments.
- Submit additional evidence like medical records or accident reports.
- Seek independent legal advice if the PIC's decision appears arbitrary.
Time limits and next steps
CTP claims must be submitted within 52 weeks of the accident, though extensions may apply for complex cases. If a dispute arises, claimants should act quickly, as delays can jeopardize benefits. The PIC's medical review pathway allows for challenges to injury assessments, but a challenge does not guarantee a changed decision.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.