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).
Elderly pedestrians involved in motor vehicle accidents in NSW may face disputes over compensation claims under the Compulsory Third Party (CTP) scheme. The Personal Injury Commission (PIC) must understand how the NSW CTP framework evaluates claims involving older individuals, particularly when disputes arise. This article explains what the PIC should expect during disputes, referencing SIRA's assessment criteria and the legal steps available in Balmain.
NSW CTP Rules for Elderly Pedestrian Claims
Under the Motor Accident Injuries Act 2017, CTP claims cover injuries caused by motor vehicles, including pedestrian accidents. SIRA (State Insurance Regulatory Authority) administers claims and evaluates injuries based on medical evidence. For elderly pedestrians, SIRA considers factors such as pre-existing conditions, recovery timelines, and the nature of injuries. Soft tissue injuries (threshold injuries) are eligible for benefits, but disputes may arise if the PIC's injuries are deemed less severe than documented.
Practical Steps and Evidence for Disputes
When disputes occur, the PIC must provide clear evidence to support their claim. Key documents include:
- Medical records showing the injury's severity and recovery progress
- Accident reports detailing the incident's circumstances
- Witness statements or CCTV footage
- Income records to demonstrate lost earnings
SIRA may challenge claims if evidence is incomplete or inconsistent. For example, if a pedestrian's recovery is slower than expected, the PIC should provide medical opinions explaining the delay.
Time Limits and Dispute Resolution
The CTP scheme has strict time limits. Benefits for threshold injuries are generally limited to 52 weeks after the accident, as per s 4.4 of the Motor Accident Injuries Act 2017. If disputes arise after this period, the PIC may need to pursue a separate claim for long-term impairment. Disputes can be resolved through SIRA's internal review process or by lodging a formal objection. The PIC should note that challenges do not guarantee a changed decision and must be supported by new evidence.
Example: Dispute Over Soft Tissue Injury
Consider an elderly pedestrian who suffered a soft tissue injury after being struck by a car. SIRA may dispute the claim if the injury is not classified as a threshold injury. The PIC must then provide medical evidence showing neurological signs or spinal nerve-root damage, as outlined in the Motor Accident Guidelines. This example highlights the need for precise documentation to meet SIRA's criteria.
When to Seek Legal Advice
Disputes over elderly pedestrian claims can be complex, especially when involving long-term recovery or pre-existing conditions. The PIC should consult a solicitor if SIRA's decision is contested or if the claim exceeds the 52-week benefit limit. Legal advice can help navigate the CTP scheme's requirements and ensure all evidence is properly submitted.
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