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).
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).
If you've suffered economic loss due to a motor accident in Albury, NSW, understanding your dispute resolution options under the NSW CTP scheme is critical. Economic loss claims typically involve lost income, reduced earning capacity, or future financial impacts. This article explains how to navigate disputes over such claims, including SIRA processes and steps to take when your claim is contested.
How SIRA Handles Economic Loss Claims
The NSW Motor Accident Injuries Act 2017 governs CTP claims, including economic loss. The State Insurance Regulatory Authority (SIRA) assesses claims based on medical evidence, income records, and the nature of the injury. Economic loss is a specific category of claim, covering lost wages, reduced future earnings, and out-of-pocket expenses. SIRA uses the Motor Accident Guidelines to evaluate whether the injury meets the threshold for economic loss compensation.
Practical Steps for Economic Loss Claims
To support your claim, gather documents such as:
- Medical records confirming the injury's impact on your ability to work
- Pay slips, tax returns, or employer statements showing lost income
- Evidence of future earning capacity, such as career plans or industry benchmarks
- Accident reports, witness statements, and photographs
SIRA may request additional information, so prompt communication with your insurer and medical professionals is essential. If your claim is denied, you can request an internal review within 28 days of the decision.
Dispute Resolution Options
If your economic loss claim is disputed, you have several options:
- Internal Review: SIRA allows a review of its decision within 28 days. This process involves reassessing the evidence and may lead to a revised claim.
- Mediation: SIRA offers mediation through the NSW Civil and Administrative Tribunal (NCAT) to resolve disputes without litigation. Mediation is confidential and can help clarify misunderstandings.
- a Personal Injury Commission (PIC) Review: For medical disputes, the PIC can review the medical evidence. This pathway is distinct from standard CTP claims and requires a separate application.
Time Limits and Key Considerations
Economic loss claims must be submitted within 52 weeks of the accident if they fall under the 'threshold injury' category. However, claims for non-threshold injuries (e.g., long-term disability) are not subject to this time limit. If your claim is disputed, act quickly: SIRA typically takes 28 days to review decisions, and delays can jeopardize your right to compensation.
Example Scenario
Consider a motorcyclist in Albury who suffered a back injury, leading to a 30% reduction in earning capacity. Their claim for lost income is disputed because the insurer argues the injury does not meet the threshold. The injured person can request an internal review, provide updated medical evidence, and seek mediation to resolve the dispute.
When to Seek Legal Advice
While SIRA provides dispute resolution pathways, complex economic loss claims often require legal assistance. A solicitor can help you:
- Navigate SIRA's internal review process
- Challenge decisions based on medical evidence
- Explore alternative dispute resolution options
- Understand how to prove long-term financial impacts
Next Steps
Economic loss claims under NSW CTP depend on the accident date, injury type, and evidence provided. To request contact about your circumstances, complete the quick, no obligation enquiry form.