Dispute Resolution for Hearing Loss Claims in NSW CTP Cases
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).
Hearing loss resulting from acoustic trauma in a motor accident may be recognised under the NSW Compulsory Third Party (CTP) scheme, but disputes can arise over entitlements. If an insurer denies or limits benefits for hearing loss, claimants have formal options to challenge the decision. These include internal review by the insurer, formal dispute resolution through the Personal Injury Commission (PIC), and, in some cases, a review by the State Insurance Regulatory Authority (SIRA). The process is governed by the Motor Accident Injuries Act 2017 and the Motor Accident Injuries Regulation 2017, which set out the framework for resolving disagreements about injury assessment, treatment entitlements, and financial benefits.
Legal Framework for Hearing Loss in CTP Claims
Hearing loss caused by the sudden noise of a motor accident, such as from airbag deployment, glass shattering, or impact forces, is considered an injury under the CTP scheme. The Motor Accident Injuries Act 2017 provides that a person may claim compensation for injury arising from a motor accident, including sensory impairments like hearing loss. The assessment of hearing loss is guided by the Motor Accident Injuries Guidelines, which require medical evidence demonstrating a measurable reduction in hearing function, typically confirmed through audiometry testing. The injury must be directly attributable to the accident and not pre-existing or caused by another factor.
Practical Steps and Evidence for Disputes
To challenge a decision denying or limiting benefits for hearing loss, claimants should gather and preserve the following evidence:
- A medical report from an audiologist or specialist ear, nose and throat (ENT) physician confirming the diagnosis and degree of hearing loss.
- Audiometric test results showing the extent of hearing impairment, including thresholds for different frequencies.
- A record of the accident, including any witness statements about loud noises at the time of impact.
- Medical treatment records showing ongoing management of the condition, such as hearing aids, tinnitus management, or counselling.
- Correspondence with the insurer, including written denials or offers that are considered inadequate.
A claimant must also ensure that the claim was made within the applicable time limits. While there is no strict deadline for making a CTP claim, delays may affect the insurer’s ability to investigate and may impact the assessment of damages.
Internal Review and Formal Dispute Resolution
If an insurer denies a claim for hearing loss or offers insufficient benefits, the first step is to request an internal review. The insurer must provide a written response within 28 days of the request. This internal review process allows the claimant to submit additional evidence and clarify medical findings.
If the internal review does not resolve the dispute, the claimant may apply to the Personal Injury Commission (PIC) for formal dispute resolution. The PIC handles disputes over injury assessment, treatment entitlements, and financial benefits. The claimant must submit a formal dispute application, including all supporting evidence. The PIC will assess the medical evidence and may order a medical examination to clarify the nature and cause of the hearing loss. The PIC’s decision is binding on the insurer and the claimant.
SIRA’s Role and Review Pathways
The State Insurance Regulatory Authority (SIRA) oversees the CTP scheme and ensures compliance with the Motor Accident Injuries Act 2017 and the Motor Accident Injuries Guidelines. While SIRA does not directly hear disputes, it has the authority to review decisions made by the PIC in certain circumstances, particularly where there is a concern about consistency in the application of the Guidelines or a breach of procedural fairness.
SIRA also publishes guidance on the assessment of sensory injuries, including hearing loss, and provides information on how medical evidence is evaluated. Claimants may refer to SIRA’s published materials when preparing for a dispute, but SIRA does not provide legal advice or represent claimants.
Hypothetical Example: Challenging a Denied Hearing Loss Claim
A 38-year-old driver was involved in a head-on collision in Sydney in June 2024. During the impact, the airbag deployed with a loud explosive sound. The driver reported immediate ringing in the ears and reduced hearing. An audiogram conducted three weeks later showed a 35-decibel hearing loss in the right ear. The insurer initially denied a claim for hearing loss, stating the injury was not permanent and did not meet the threshold for statutory benefits. The claimant obtained a second opinion from a specialist audiologist, who confirmed a permanent sensorineural hearing loss. The claimant submitted the new medical evidence and applied to the Personal Injury Commission. The PIC reviewed the evidence and ordered a medical assessment. After review, the PIC found that the hearing loss was attributable to the accident and awarded statutory benefits and treatment for hearing aids. The insurer was required to comply with the PIC’s decision.
Important Limitations and Next Steps
A challenge to a CTP decision does not guarantee a change in outcome. The insurer may still dispute the medical evidence or the causal link to the accident. The PIC’s decision is based on the available evidence and the application of the Motor Accident Injuries Guidelines. There is no right to a hearing in the PIC process, but claimants may submit written submissions and evidence.
Time limits for making a claim or appealing a decision may apply, particularly if the claimant is seeking damages. The 52-week rule under the Motor Accident Injuries Act 2017 limits weekly payments and treatment benefits if the only injuries are threshold injuries, but hearing loss may qualify as a non-threshold injury if it results in a permanent impairment. The distinction between threshold and non-threshold injuries is critical and must be assessed by a qualified medical practitioner.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.