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 CTP claims are assessed based on medical evidence and SIRA guidelines. This article explains how scarring injuries are evaluated, what evidence is required, and practical considerations for regional NSW claimants.
How Facial Scarring Injuries Are Assessed Under NSW CTP
Under the Motor Accident Injuries Act 2017, facial scarring injuries are evaluated using the SIRA Motor Accident Guidelines. Scarring is considered a threshold injury if it meets specific clinical criteria, such as visible, long-lasting scars affecting appearance or function. For example, a deep laceration requiring stitches that leaves a noticeable scar may qualify as a threshold injury. However, the injury must not be classified as a 'minor injury' under the guidelines. SIRA provides detailed criteria for assessing scarring, including photographic documentation and medical reports.
Evidence Required for Scarring Claims in Regional NSW
Claimants must provide medical evidence to support scarring claims. This includes:
- Detailed medical records from a registered medical practitioner
- Photographs of the injury taken at the time of treatment
- Expert opinion from a medical professional confirming the scarring's permanence and impact
In regional NSW, access to specialists may be limited, so claimants should seek a second opinion if needed. SIRA recommends using approved medical practitioners to assess scarring injuries.
How CTP Insurers Evaluate Long-Term Impacts
CTP insurers assess scarring claims based on:
- Severity: Does the scar significantly affect appearance or function? For example, a scar covering 30% of the face may be considered more severe than a small, superficial mark.
- Longevity: Is the scarring permanent? Temporary scars (e.g., from a minor cut) may not qualify as threshold injuries.
- Psychological impact: SIRA guidelines note that scarring can affect a person's quality of life, including social and emotional distress.
Insurers may also consider cosmetic treatment costs if the scarring requires ongoing care, such as laser therapy or surgery.
Common Challenges for Regional NSW Claimants
Regional claimants may face delays in accessing medical specialists or obtaining accurate assessments. For example, a person in Dubbo with a facial scar might struggle to find a dermatologist or plastic surgeon to evaluate the injury. Additionally, documenting the injury's impact can be difficult without local support networks. Claimants should:
- Keep all medical records and correspondence
- Request a written assessment from their treating doctor
- Seek assistance from local legal services or SIRA's free advice line
When to Seek Legal Advice
CTP claims involving scarring injuries can be complex. Legal advice is recommended if:
- The claimant is unsure whether their injury meets threshold criteria
- The insurer disputes the scarring's permanence
- The claimant needs help navigating SIRA's claims process
Time limits also apply. Most CTP claims must be submitted within 52 weeks of the accident, though exceptions exist for certain injuries.
Next Steps
Facial scarring injuries under NSW CTP claims require careful documentation and understanding of SIRA guidelines. If you're in regional NSW and have questions about your claim, seek professional advice to ensure your rights are protected.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.