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).
Facial scarring injuries under NSW's Compulsory Third Party (CTP) scheme have undergone significant changes since the 2017 reforms. These changes, which apply in Ballina and across New South Wales, now determine how injuries like facial lacerations, scarring, and cosmetic damage are assessed for compensation. This article explains the practical impact of the reforms on SIRA's evaluation process, what evidence matters, and how claimants should prepare.
What Changed in the 2017 CTP Reforms
The 2017 reforms shifted NSW's motor accident compensation system from a common law model to a statutory benefits framework. Key changes affecting facial scarring claims include:
- Statutory benefits replaced common law damages: Under the Motor Accident Injuries Act 2017, facial scarring injuries are now assessed using predefined statutory benefits rather than being treated as general damages claims. This means scarring injuries are evaluated based on their impact on daily life, not just their severity.
- SIRA's role in assessing scarring: The State Insurance Regulatory Authority (SIRA) now oversees claims for facial scarring under the revised framework. SIRA uses the Motor Accident Guidelines to determine if a scarring injury qualifies for benefits, focusing on visible, long-term effects rather than temporary or minor injuries.
- Threshold injury criteria: Facial scarring injuries must meet the 'threshold injury' definition in the Motor Accident Injuries Act 2017. This requires the injury to result in a 'significant and lasting impact' on the claimant's physical or psychological well-being. Minor cuts or superficial scars typically do not qualify.
What Evidence Matters for Facial Scarring Claims
To support a facial scarring claim under the 2017 reforms, claimants must provide:
- Medical documentation: A doctor's report confirming the scarring injury, its cause, and its effect on daily life. This should include details of the accident, the nature of the scarring, and any psychological impact.
- Photographic evidence: Clear photos of the scarring injury, taken before and after treatment, to demonstrate its visible impact. These should be dated and include a reference to the accident date.
- Evidence of long-term effects: Documentation showing how the scarring affects the claimant's life, such as difficulty with social interactions, employment, or self-esteem. This may include psychologist reports or statements from family members.
- Witness statements: Accounts from witnesses confirming the accident and the nature of the scarring injury. This is particularly important if the injury was not immediately visible or if there was a delay in seeking treatment.
Time Limits and Dispute Options
Claimants must notify their insurer within 52 weeks of the accident, as per the Motor Accident Injuries Act 2017. If the injury is classified as a 'threshold injury, ' benefits are generally limited to 52 weeks unless the claimant can demonstrate ongoing long-term effects. Disputes over scarring claims can be resolved through SIRA's review process, which may involve an independent medical assessment.
A Hypothetical Example
Consider a claimant who suffered a facial laceration in a car accident in Ballina. The injury resulted in a visible scar that caused social anxiety and affected their ability to work. Under the 2017 reforms, this claim would be assessed based on:
- Whether the scar meets the threshold injury criteria (i.e., it is visible and has a lasting impact);
- The claimant's medical records confirming the injury's effect on their daily life;
- Evidence of psychological distress, such as a psychologist's report.
If the claimant can demonstrate that the scarring injury significantly impacts their life, they may qualify for statutory benefits under the revised CTP framework.
When to Seek Legal Advice
The 2017 reforms have changed how facial scarring injuries are assessed, and claimants must ensure their evidence aligns with SIRA's updated criteria. If you're unsure whether your scarring injury qualifies for compensation, or if your claim has been disputed, it's important to seek legal advice. A solicitor can help you navigate the process, ensure all required documentation is submitted, and challenge any incorrect assessments.
Next Steps
CTP entitlements and deadlines depend on the accident date, injury type, and claim history. To request contact about your circumstances, complete the quick, no obligation enquiry form.