Facial Scarring and CTP Claims in NSW
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 New South Wales, understanding how the Personal Injury Commission (PIC) evaluates your claim is critical. Under the Motor Accident Injuries Act 2017, scarring injuries must meet specific criteria to qualify for compensation. The PIC assesses whether the scarring impacts your quality of life, and disputes often arise over the severity of the injury. This article explains what evidence the PIC requires, how SIRA evaluates facial scarring, and steps to take if your claim is challenged.
How SIRA Assesses Facial Scarring Claims
The State Insurance Regulatory Authority (SIRA) oversees CTP claims in NSW. When assessing facial scarring, SIRA considers:
- Medical evidence: Detailed reports from a registered medical practitioner confirming the scarring's location, depth, and impact on daily life.
- Quality of life impact: Whether the scarring causes psychological distress, social stigma, or functional limitations (e.g., difficulty speaking or eating).
- Cosmetic injury criteria: Under the Motor Accident Guidelines, scarring must meet specific thresholds to qualify as a 'threshold injury' or 'permanent impairment' (e.g., visible scarring affecting appearance or causing chronic pain).
SIRA also evaluates whether the scarring is permanent and whether it meets the 'spinal nerve-root qualification' if neurological signs are involved.
Practical Steps for Facial Scarring Claims
To support your claim, gather:
- Medical records documenting the injury, including photographs and treatment history.
- A detailed accident report from the police or insurance company.
- Witness statements or photos of the scarring.
- Income records if you've lost earnings due to treatment or recovery.
If your claim is disputed, the PIC may request an independent medical review. Ensure your medical team clearly explains how the scarring affects your life, as this is central to SIRA's assessment.
Time Limits and Dispute Resolution
You have three years from the accident date to file a CTP claim under the Motor Accident Injuries Act 2017. If your claim is challenged, you can:
- Request an internal review with the PIC to challenge the assessment.
- Seek an independent medical opinion to dispute the impairment rating.
- Appeal to the NSW Civil and Administrative Tribunal (NCAT) if the PIC's decision is unsatisfactory.
Note that a challenge does not guarantee a changed decision. The PIC must be satisfied the original assessment was incorrect.
Example of a Facial Scarring Dispute
Consider a claimant who suffered a deep laceration to the cheek during a collision. The PIC disputes whether the scarring qualifies as a 'threshold injury' under the Motor Accident Guidelines. The claimant provides medical evidence showing the scar is visible, causes chronic pain, and affects their ability to work in customer-facing roles. SIRA may then require an independent assessment to determine if the scarring meets the injury threshold.
When to Seek Legal Advice
Disputes over facial scarring can be complex, especially if the PIC challenges the severity of the injury. A solicitor can help:
- Navigate the PIC's internal review process.
- Challenge the medical opinion used to assess your claim.
- Ensure all evidence meets SIRA's requirements.
If you're unsure how to proceed, contact a legal professional for guidance. Every claim depends on its own facts.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.