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).
NSW CTP insurers assess liability by evaluating fault, evidence, and policy terms under the Motor Accident Injuries Act 2017. In Armidale, claimants must understand how insurers determine responsibility and what evidence matters. This article explains the process, including SIRA guidelines and steps to improve your claim.
Factors Insurers Consider
NSW CTP insurers assess liability by examining:
- Fault determination - Whether the accident involved a motor vehicle and if the driver breached duty of care.
- Evidence - Police reports, witness statements, medical records, and accident scene photos.
- Policy terms - Whether the insured vehicle was registered and had valid CTP cover.
- SIRA guidelines - The State Insurance Regulatory Authority (SIRA) sets standards for assessing injuries and benefits.
Insurers must prove the accident involved a motor vehicle and that the injury meets the threshold injury definition under the Motor Accident Injuries Act 2017. For example, a minor collision with no visible damage might still qualify if medical evidence shows soft tissue injury.
SIRA's Role in Liability Assessments
SIRA provides the framework for insurers to evaluate claims. Key principles include:
- Threshold injury - Injuries like whiplash or soft tissue damage that meet specific clinical criteria.
- 52-week rule - Benefits for threshold injuries are generally limited after 52 weeks unless the injury meets whole person impairment thresholds.
- Evidence-based approach - Insurers must rely on medical reports and clinical guidelines to assess injury severity.
In Armidale, SIRA’s guidelines ensure consistency in how insurers evaluate claims. For instance, if a claimant’s injury is classified as a threshold injury, insurers must apply the 52-week benefit cap unless there’s evidence of long-term impairment.
Steps to Improve Your Claim
To help insurers assess liability fairly, claimants should:
- Document the accident - Take photos, note vehicle details, and obtain witness contact information.
- Seek medical attention - Ensure injuries are recorded in medical records, as this is critical for proving liability.
- Notify the insurer - Contact the at-fault driver’s CTP insurer promptly to start the claims process.
- Review evidence - Ensure all accident reports and medical records are complete and accurate.
If your claim is disputed, you may need to request a review under the Motor Accident Injuries Act 2017. Insurers must provide a written explanation of their liability decision.
Example: How Liability is Assessed
Consider a minor collision in Armidale where a car hits a pedestrian. The insurer would:
- Check if the vehicle had valid CTP cover.
- Review police reports to confirm fault.
- Assess medical records to determine if the injury meets threshold injury criteria.
- Apply the 52-week benefit cap if the injury is classified as a threshold injury.
This process ensures insurers evaluate claims consistently while protecting claimants’ rights.
When to Seek Advice
Time limits apply to CTP claims. For example, you must notify the insurer within 52 weeks of the accident to claim benefits for threshold injuries. If your claim involves complex issues like long-term impairment or disputes over fault, consult a legal professional 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.