How NSW CTP Insurers Evaluate Hearing Loss Claims
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).
If you've suffered hearing loss due to acoustic trauma in a motor accident in Newcastle or Hunter, understanding how insurers assess liability is critical. NSW CTP insurers base their decisions on the Motor Accident Injuries Act 2017 and SIRA guidelines. Key factors include medical evidence of injury, the accident's circumstances, and whether the injury meets the 'threshold injury' definition. This article explains the process and what you need to prove.
Key CTP Rules for Hearing Loss Claims
Under the Motor Accident Injuries Act 2017, CTP insurers must cover injuries caused by motor vehicle accidents, including acoustic trauma. SIRA guidelines define 'threshold injury' as a condition that requires treatment and has a measurable impact on daily life. For hearing loss claims, this typically means:
- A medical diagnosis of acoustic trauma or noise-induced hearing loss
- Evidence of treatment, such as audiograms or specialist reports
- A connection between the injury and the accident
Insurers may also consider whether the injury falls under the 'soft tissue' category, which includes injuries like concussions or whiplash. However, hearing loss is generally treated as a separate claim under the 'loss of hearing' category.
What Evidence Matters for Your Claim
To support your claim, you'll need:
- Medical records: Detailed reports from audiologists or ENT specialists confirming the injury and its cause.
- Accident details: Police reports, witness statements, and vehicle data (if available) to show how the injury occurred.
- Pre-accident hearing status: Evidence that your hearing was normal before the accident.
- Impact on daily life: Documentation of how the injury affects your work, social life, or safety (e.g., difficulty using phones or hearing alarms).
Insurers may request these documents to assess whether your injury meets the threshold for compensation.
Time Limits and Dispute Options
You have 52 weeks from the accident date to claim benefits for 'only injuries' (threshold injuries) under the Motor Accident Injuries Act 2017 s 4.4. If your injury is not a threshold injury, you may have longer to pursue a claim. If your claim is denied, you can:
- Request a review of the decision
- Seek mediation through SIRA
- Consult a solicitor to challenge the insurer's assessment
Disputes often arise when insurers dispute the link between the accident and the injury, or question the severity of the hearing loss.
When to Seek Legal Advice
Speak to a solicitor if:
- Your claim is denied and you're unsure how to respond
- You have a complex injury (e.g., mixed threshold and non-threshold injuries)
- You need help navigating SIRA's review process
Legal professionals can help you challenge an insurer's decision or negotiate a fair settlement.
Example: How an Insurer Might Assess a Claim
Imagine a driver involved in a car crash where the airbag deployed with excessive force. The driver later develops hearing loss diagnosed as acoustic trauma. The insurer would:
- Review medical records to confirm the injury
- Assess whether the injury meets the threshold injury definition
- Determine if the injury is linked to the accident
- Calculate benefits based on the injury's impact
If the insurer disputes the claim, they may request additional evidence or refer the case to a specialist.
Next Steps
CTP entitlements depend on the accident date, injury type, and claim history. To discuss your circumstances, complete the quick, no obligation enquiry form. Every claim depends on its own facts.