If you were injured in a motor accident caused by a driver who was intoxicated, you may be entitled to compensation under the NSW Compulsory Third Party (CTP) insurance scheme. This claim is governed by the Motor Accident Injuries Act 2017 (MAIA), which provides for treatment and care benefits, weekly income payments, and, in some cases, damages for pain and suffering. The process of preparing for medical assessments is a critical step in establishing your claim, particularly when the accident involved a drunk driver, as the circumstances may affect the assessment of injury severity and causation.
Medical assessments are conducted to determine the nature and extent of your injuries, assess any permanent impairment, and establish whether you meet the threshold for claiming damages. These assessments are carried out under the Motor Accident Injuries Regulation 2017 and guided by the Motor Accident Injuries (Medical Assessment) Guidelines issued by the State Insurance Regulatory Authority (SIRA). For victims of drunk driver incidents, the assessment process remains the same in law, but the presence of alcohol impairment may be relevant to establishing fault and the seriousness of the incident.
To prepare for a medical assessment, you should first ensure that all medical treatment related to the accident has been documented. This includes records from emergency departments, specialist consultations, physiotherapy, and any mental health support. Keep copies of all medical reports, imaging results (such as MRI or CT scans), and treatment plans. These documents form the foundation of your claim and help the assessor understand the full context of your injuries.
You should also gather evidence that supports the circumstances of the accident. This includes a police report, if one was filed, and any witness contact details. If the driver was found to be over the legal alcohol limit, this may be noted in the police report and could be relevant to establishing the driver’s negligence, which may affect liability considerations under the CTP scheme. However, under the MAIA, you do not need to prove fault to access treatment and care benefits or weekly payments. The CTP insurer is required to pay these benefits regardless of who was at fault.
When attending the medical assessment, bring the following:
- A completed medical history form provided by your CTP insurer or legal representative
- All relevant medical records and reports
- A list of medications you are currently taking
- A record of any work absences or reduced capacity since the accident
- A written summary of how your injuries have affected your daily life, including work, family, and social activities
The assessor will typically ask questions about your symptoms, how they have changed over time, and how they impact your ability to perform everyday tasks. They may also conduct a physical examination and review your medical imaging. It is important to be honest and specific in your responses. Do not exaggerate, but also do not minimise your symptoms. The assessment is not about determining blame, but about accurately recording the effect of the injuries.
A common point of confusion is the distinction between treatment and care benefits and damages. Treatment and care benefits cover medical and rehabilitation expenses, while weekly income payments are available if you have lost income due to the injury. Damages for pain and suffering are only available if you have a threshold injury, which includes certain types of soft tissue injury, and if your whole person impairment is assessed at 10% or more. For a drunk driver accident, the presence of alcohol may not change the threshold test, but it may be considered in relation to the severity of the impact and the resulting injury pattern.
If you disagree with the outcome of a medical assessment, you may request a review. This can be done by contacting your CTP insurer or seeking independent advice. You may also apply to the NSW Civil and Administrative Tribunal (NCAT) for a review of the assessment if you believe it was incorrect or unfair. However, you must act within the time limits set by the MAIA. These time limits vary depending on whether you are claiming benefits or damages, and they are strict.
A hypothetical example: A pedestrian in Sydney was struck by a car driven by a person with a blood alcohol concentration of 0.12, well above the legal limit. The pedestrian sustained a whiplash injury and a minor concussion. After six months of treatment, a medical assessment found a 12% whole person impairment due to soft tissue injury. Because the injury met the threshold, the pedestrian was eligible to claim damages. The assessment was supported by MRI evidence, a neurologist’s report, and a detailed diary of pain and functional limitations.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.