Elderly Pedestrian Injuries, What the PIC Expects in Disputes (Ashfield)
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).
If you're an elderly pedestrian injured in a motor vehicle accident in NSW, understanding what the Personal Injury Commission (PIC) expects during disputes is critical. Under the NSW Compulsory Third Party (CTP) scheme, claimants must demonstrate that their injuries meet specific criteria to qualify for benefits. This article explains how SIRA evaluates claims, common disputes involving older pedestrians, and practical steps to prepare for negotiations.
NSW CTP Rules for Elderly Pedestrian Claims
The Motor Accident Injuries Act 2017 governs CTP claims in NSW. For elderly pedestrians, the PIC assesses injuries based on the Motor Accident Guidelines, which define 'threshold injuries' and 'whole person impairment' (WPI). Key considerations include:
- Medical Evidence: Doctors must document injuries using the guidelines. Age-related factors like pre-existing conditions or slower recovery may influence assessments.
- Spinal Nerve-Root Qualification: Soft tissue injuries must involve neurological signs beyond radiculopathy to qualify under the threshold definition.
- Dispute Focus: Insurers often challenge claims by disputing the link between the accident and injuries, or questioning the severity of age-related complications.
Practical Steps and Evidence for Elderly Pedestrian Claims
To support your claim, gather:
- Medical Records: Include all post-accident treatments, specialist reports, and evidence of pre-existing conditions.
- Accident Details: Police reports, witness statements, and photographs of the scene are crucial.
- Income and Expenses: Document lost wages, care costs, and any out-of-pocket medical expenses.
- Age-Related Impact: Provide evidence of how your age affects recovery, such as slower healing or increased risk of complications.
A hypothetical example: An 82-year-old pedestrian with a history of arthritis claims a knee injury. The insurer disputes the link to the accident. SIRA would require medical evidence showing the injury worsened due to the accident, not pre-existing conditions.
Time Limits, Disputes and When to Seek Advice
CTP claims must be submitted within 52 weeks of the accident (s 3.28 of the Motor Accident Injuries Act 2017). If your injury is a 'threshold injury', benefits may stop after 52 weeks unless you meet the WPI threshold. Disputes often arise over:
- Whether your injury qualifies as a threshold injury.
- The extent of your impairment, especially if age affects recovery.
- The need for ongoing treatment or care.
If your claim is challenged, you may request a medical review through the PIC's internal dispute pathway. Note that challenges do not guarantee a changed decision.
Next Steps for Elderly Pedestrian Claimants
CTP entitlements depend on the accident date, injury type, and claim history. To ensure your claim is properly assessed, complete the quick, no obligation enquiry form to discuss your circumstances with a legal professional.