How SIRA Handles CTP Claims for Elderly Pedestrians in NSW
If you are an elderly pedestrian who was struck by a vehicle in Greater Sydney, you may be entitled to compensation under the NSW Compulsory Third Party (CTP) insurance scheme. The State Insurance Regulatory Authority (SIRA) administers this scheme and provides clear guidance on how claims are assessed, particularly for older road users who may face greater challenges in recovery. SIRA’s approach focuses on the nature and impact of injuries, not age alone, but recognises that age can influence recovery time, treatment needs and long-term outcomes. This means that while age is not a barrier to claiming, it may affect how benefits and damages are calculated.
The Legal Framework for CTP Claims in NSW
All CTP claims in NSW are governed by the Motor Accident Injuries Act 2017 (MAIA), which replaced the older Motor Accidents Compensation Act 1999. This law sets out what injuries are compensable, how benefits are calculated, and the limits on claims. Under MAIA, you may be entitled to treatment and care benefits, weekly income payments, and damages for pain and suffering, loss of enjoyment of life, and future care needs. These benefits apply regardless of fault, as long as the injury occurred in a motor vehicle accident.
SIRA’s role is to ensure that claims are assessed fairly and consistently across the state, including in Greater Sydney. The Motor Accident Injuries Regulation 2017 and the Motor Accident Guidelines provide detailed instructions on how injuries are assessed, including for older adults. These documents confirm that age is a factor in determining the extent of future care needs and the impact of injury on daily life, but it is not a standalone reason to deny a claim.
What Damages Can Be Claimed for Elderly Pedestrian Injuries?
Under MAIA, you may claim damages if your injuries meet the threshold for a permanent impairment. This means the injury must result in a whole person impairment (WPI) of at least 10%. For elderly pedestrians, common injuries include fractures (such as hip or wrist fractures), head trauma, and soft tissue injuries. SIRA assesses whether these injuries are permanent and how they affect your ability to perform daily activities.
If your injury does not meet the threshold, you may still receive treatment and care benefits and weekly income payments for up to 52 weeks, unless your injury is determined to be a threshold injury. In that case, benefits are generally limited to 52 weeks. However, if your injury is a threshold injury and you are over 65, SIRA may still allow a claim for damages if the injury has a significant impact on your life, particularly if it affects mobility, independence, or mental health.
SIRA considers factors such as pre-existing health conditions, recovery time, and the need for ongoing care when assessing claims. For example, an elderly person who suffers a hip fracture may require longer recovery time, more intensive rehabilitation, and greater long-term support than a younger person. These factors are taken into account when calculating damages for pain and suffering and future care needs.
Evidence That Matters in Elderly Pedestrian Claims
To support a claim, you must provide evidence that shows the nature of your injuries, their impact on your life, and the extent of any permanent impairment. Key evidence includes:
- Medical records from emergency departments, specialists, and rehabilitation providers
- A report from a qualified medical assessor detailing your whole person impairment (WPI)
- A statement from your treating practitioner on your recovery progress and future care needs
- Photographs of the accident scene, your injuries, or any assistive devices used
- Witness statements, if available, confirming the circumstances of the collision
- Records of lost income or reduced capacity to perform household duties
SIRA also considers whether the injury was caused by a motor vehicle accident, including in private property or car parks, as long as the vehicle was being used in a way that constitutes a motor accident under MAIA. For elderly pedestrians, SIRA may assess whether the injury was foreseeable given the individual’s age and pre-existing conditions, but this does not reduce entitlement to benefits.
Time Limits and Procedural Steps
There are time limits for making a CTP claim. You must notify the insurer of the motor vehicle involved within 3 months of the accident. This is a strict deadline, and failure to meet it may result in a claim being denied. You must also apply for benefits within 6 months of the accident, or within 3 months of receiving a medical assessment, whichever is later.
If you are unable to make a claim yourself due to age, injury, or cognitive impairment, a legal personal representative may act on your behalf. SIRA provides forms and guidance for this process, and it is advisable to seek assistance from a legal professional if you are unsure of your rights.
A claim for damages must be made within 3 years of the accident. This is a fixed deadline, and it cannot be extended unless special circumstances apply. SIRA may consider whether the claim was made in good faith and whether the delay was reasonable, but this is not guaranteed.
When to Seek Independent Advice
While SIRA provides clear guidelines, the assessment of your claim depends on your individual circumstances. Age, pre-existing health conditions, and the nature of your injuries all play a role in determining the value of your claim. If you believe your injuries have a lasting impact on your independence, mobility, or mental health, it may be beneficial to seek independent legal advice to ensure your claim is properly assessed.
SIRA does not provide legal advice, and it is not a substitute for a qualified solicitor. If you are considering a claim for damages, particularly for a permanent impairment, it is important to understand how your age and injury interact under the law. SIRA’s assessment is not final and can be reviewed if new evidence emerges.
A Realistic Example
An 82-year-old woman was struck by a car while crossing a street in Sydney’s inner west. She sustained a hip fracture and required surgery and six months of rehabilitation. Her treating doctor confirmed that she would not regain full mobility and would need ongoing support with daily tasks. A medical assessor determined her WPI was 18%. SIRA accepted that her injury met the threshold for damages, and she was awarded compensation for pain and suffering, future care needs, and loss of enjoyment of life. The claim was made within the 6-month window, and the damages were calculated based on her age, recovery trajectory, and long-term care requirements.
Next Steps
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.