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 from a motor accident in NSW may be assessed for compensation under the Compulsory Third Party (CTP) insurance scheme. If an insurer disputes the extent, impact or permanence of the scarring, claimants in Bankstown have formal options to seek resolution through the State Insurance Regulatory Authority (SIRA) and the Personal Injury Commission. These processes are governed by the Motor Accident Injuries Act 2017 and the Motor Accident Injuries Regulation 2017, which set out how injuries are assessed and how disputes may be resolved. The outcome depends on medical evidence, the nature of the scarring, and whether it affects function, appearance or psychological wellbeing.
The Motor Accident Injuries Act 2017 establishes a structured approach to injury assessment. For facial scarring, the insurer or SIRA may assess whether the injury constitutes a permanent impairment, particularly if it affects facial function, causes ongoing pain, or results in visible disfigurement that impacts daily life or mental health. The assessment is guided by the Motor Accident Guidelines, which define how scarring is evaluated, including its location, size, depth, and long-term visibility. Scarring that results in a permanent change to appearance may be assessed under the whole person impairment (WPI) framework, which determines a percentage of impairment used to calculate compensation for non-economic loss.
If a claimant disagrees with an insurer’s assessment of facial scarring, they may initiate a dispute resolution process. The first step is to request an internal review from the insurer. Insurers are required to respond within 21 days of receiving a formal dispute request. This internal review may result in a revised assessment or a refusal to change the initial decision. If the insurer maintains its position, the claimant may then apply to the Personal Injury Commission (PIC) for a formal review. The PIC is an independent body that hears disputes about injury assessment, treatment, and entitlement to benefits. A claimant must submit a written application, supported by medical evidence, to the PIC within 12 months of the insurer’s final decision.
Medical evidence is critical in facial scarring disputes. This includes photographs taken at the time of injury and at follow-up appointments, clinical notes from dermatologists or plastic surgeons, and a formal assessment of whole person impairment by a qualified medical practitioner. The assessment must detail how the scarring affects function, appearance, and psychological wellbeing. A claimant may also submit evidence of emotional distress, such as a psychologist’s report, if the scarring has led to anxiety, depression, or social withdrawal. The PIC will consider all evidence and may order a medical examination to clarify the nature and impact of the injury.
In some cases, the dispute may relate to the insurer’s refusal to fund reconstructive surgery or cosmetic procedures. Under the CTP scheme, treatment and care benefits are available for injuries that are not considered minor or threshold injuries. If facial scarring is not classified as a threshold injury, the insurer must fund reasonable and necessary treatment, including surgery to improve function or appearance. A claimant who believes treatment is being denied may apply to the PIC for a determination on treatment entitlement. The PIC has the authority to order the insurer to fund treatment if it deems the procedure reasonable and necessary.
The process of dispute resolution may take several months. The PIC aims to resolve disputes within 120 days of receiving a complete application, but delays can occur if additional medical evidence is required. A claimant is not required to attend a hearing unless they choose to do so. The PIC may issue a determination that upholds, varies, or rejects the insurer’s original decision. If the determination is in favour of the claimant, the insurer must comply within 14 days.
The PIC’s role is to review the evidence and apply the law as set out in the Motor Accident Injuries Act 2017 and the Motor Accident Guidelines. The insurer may still appeal a PIC determination to the NSW Civil and Administrative Tribunal (NCAT), but only on a point of law. The claimant may also seek a review of the decision if new medical evidence emerges.
A claimant in Bankstown who has experienced facial scarring following a motor accident should preserve all records related to the injury, including medical reports, photographs, and correspondence with the insurer. They should also document any impact on daily life, such as changes in work performance, social activity, or mental health. These details may support a claim for non-economic loss or psychological injury.
For example, a 32-year-old cyclist in Bankstown sustained a deep laceration across the cheek during a collision with a car in February 2024. The injury healed but left a visible scar. The insurer assessed the scarring as a minor, non-compensable injury. The claimant obtained a medical report from a plastic surgeon confirming a 5% WPI due to permanent disfigurement and a psychologist’s report indicating ongoing anxiety related to appearance. The claimant applied to the PIC for review, and the determination upheld the WPI assessment and awarded compensation for non-economic loss.
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