Facial Scarring in NSW CTP Claims: What the PIC Can Expect in Disputes (Albury)
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).
If you've suffered facial scarring from a motor accident in NSW, understanding how SIRA evaluates your claim is critical. Facial scarring injuries are assessed based on medical evidence, the impact on your daily life, and whether the injury meets the threshold for compensation under the Motor Accident Injuries Act 2017. This article explains what evidence claimants (PICs) need to prove in disputes, how SIRA assesses scarring claims, and practical steps to challenge unfair assessments.
How SIRA Evaluates Facial Scarring Claims
SIRA uses the Motor Accident Guidelines to determine the severity of facial scarring injuries. Key factors include:
- Medical evidence: Detailed records from a medical practitioner confirming the scarring, its location, and duration.
- Impact on daily life: Documentation showing how the scarring affects your ability to work, socialise, or perform everyday tasks.
- Cosmetic impact: Evidence of visible scarring that causes psychological distress or social stigma.
Under the Motor Accident Injuries Act 2017, scarring may qualify as a 'threshold injury' if it meets specific clinical criteria. However, SIRA may dispute claims if the scarring is deemed minor or if the injury does not meet the threshold for compensation.
Evidence Required to Prove Facial Scarring
To challenge an insurer's assessment, you must provide:
- Photographs: Clear images of the scarring taken at the time of the injury and during follow-up appointments.
- Medical reports: From a specialist, including before-and-after assessments of the scarring.
- Expert opinion: A dermatologist or plastic surgeon's opinion on the scarring's permanence and impact.
- Daily life records: Diaries or testimonials showing how the scarring affects your work, relationships, or mental health.
A hypothetical example: A claimant with a visible scar across their forehead may need to show how the scarring causes anxiety during social interactions, as well as medical evidence confirming the scar's permanence.
Dispute Resolution Options for Facial Scarring Claims
If your claim is disputed, you can:
- Request an internal review with SIRA. This must be done within 28 days of receiving the decision.
- Use the Personal Injury Commission (PIC) medical dispute pathway. This allows a medical expert to review your case and provide an independent opinion.
- Seek legal advice if the dispute escalates. A solicitor can help challenge SIRA's assessment or negotiate a better outcome.
It's important to note that disputing a claim does not guarantee a change in the decision. SIRA has the final authority to determine compensation, and legal challenges are rare.
Time Limits and Practical Steps for Albury Claimants
CTP claims must be submitted within 52 weeks of the accident, unless an extension is granted. For facial scarring claims, delays in seeking medical attention or submitting evidence may weaken your case. In Albury, claimants should:
- Notify the insurer immediately after the accident.
- Seek medical attention to document the scarring.
- Preserve all evidence, including accident reports, witness statements, and photographs.
- Submit your claim within the 52-week deadline.
If your claim is denied, you have 28 days to request an internal review. After that, you may need to escalate the matter through the PIC or legal channels.
When to Seek Legal Advice
Disputes over facial scarring can be complex, especially if the injury is contested as a 'threshold injury.' A solicitor can help you:
- Challenge SIRA's assessment of your scarring.
- Negotiate a fair settlement.
- Explore options for legal action if the dispute escalates.
However, legal advice is not guaranteed to result in a successful claim. Each case depends on the facts, evidence, and applicable law.
Next Steps for Albury Claimants
If you're facing a dispute over your facial scarring injury, time and evidence are critical. While SIRA has the final say, you have options to challenge their decision. Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.