Understanding Facial Scarring Claims in NSW CTP
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).
- Facial scarring injuries under NSW Compulsory Third Party (CTP) claims are assessed based on the severity of the scarring, its visibility, and its impact on the injured person’s daily life. Insurers use the
- Motor Accident Guidelines* and
- SIRA* (State Insurance Regulatory Authority) criteria to determine whether a claimant qualifies for benefits. In Western Sydney, claimants must understand how insurers evaluate scarring to challenge decisions or seek fair compensation.
Key Factors in Insurer Assessments
NSW CTP insurers assess facial scarring injuries by considering:
- Visibility: Scars that are visible to others, such as on the face or neck, are more likely to be considered significant.
- Impact on daily life: Insurers evaluate whether the scarring affects the claimant’s ability to work, socialise, or perform everyday tasks.
- Medical evidence: Doctors must document the injury’s severity, including photographs and clinical notes, to support the claim.
- SIRA guidelines: The Motor Accident Guidelines define threshold injuries, which include soft tissue injuries like facial lacerations. Scarring that meets these criteria may qualify for benefits.
Practical Steps for Claimants
To support a facial scarring claim, claimants should:
- Obtain a medical report from a registered medical practitioner detailing the injury’s impact.
- Take clear photographs of the scarring before and after treatment.
- Keep records of any psychological effects, such as anxiety or depression, caused by the scarring.
- Notify the at-fault driver’s insurer promptly, as time limits apply.
Time Limits and Dispute Options
- CTP claims must be submitted within 52 weeks of the accident if the injury is classified as a
- threshold injury* under the
- Motor Accident Injuries Act 2017*. If the scarring is not a threshold injury, claimants may need to pursue a common law damages claim separately. Claimants can dispute insurer decisions by:
- Submitting a formal objection to the insurer with supporting evidence.
- Seeking a review by SIRA if the claim is rejected.
When to Seek Legal Advice
Insurers may undervalue facial scarring claims, especially if the injury is not classified as a threshold injury. Claimants in Western Sydney should consult a solicitor if:
- The insurer refuses to pay benefits.
- The claimant’s scarring affects their employment or social life.
- The injury is not clearly documented in medical records.
Example Scenario
A claimant in Western Sydney sustains a facial laceration in a car accident. The scar is visible and causes social anxiety. The insurer dismisses the claim, arguing the injury is a minor soft tissue wound. However, the claimant’s medical records show the scar impacts their mental health, and the injury meets the threshold injury criteria under the Motor Accident Guidelines. This example highlights how insurers may misclassify scarring injuries and why thorough documentation is critical.
Next Steps
CTP entitlements depend on the accident date, injury type, and claim history. To request contact about your circumstances, complete the quick, no obligation enquiry form.