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 hearing loss from a road accident in New South Wales and are preparing for a medical assessment under the Compulsory Third Party (CTP) scheme, understanding the evidence required and the process is critical. This article explains how to prepare for assessments, what SIRA expects for acoustic trauma claims, and when to seek legal advice.
What Evidence Proves Hearing Loss from a Road Accident?
Under the NSW CTP scheme, claims for hearing loss must be supported by medical evidence showing a direct link between the accident and the injury. Key evidence includes:
- Audiological reports from a qualified audiologist or ENT specialist, detailing hearing thresholds and any permanent damage.
- Medical records confirming the injury's onset date and its connection to the accident.
- Expert opinion from a medical practitioner assessing the injury's impact on daily life.
- Witness statements or accident reports that corroborate the incident.
For acoustic trauma specifically, SIRA requires documentation of spinal nerve-root injuries or radiculopathy if neurological signs are present. This is outlined in the Motor Accident Guidelines, which define how hearing loss is assessed under the Motor Accident Injuries Act 2017.
How SIRA Assesses Acoustic Trauma Claims in Regional NSW
SIRA evaluates all claims based on the Motor Accident Guidelines, which specify that hearing loss must meet the threshold injury criteria. In regional areas, claimants may face additional challenges accessing specialists or audiologists. To address this:
- Request a referral to a SIRA-approved medical expert if your local doctor cannot provide the required assessment.
- Arrange assessments through your insurer, as they must cover necessary medical evaluations under the CTP scheme.
- Document all communications with insurers and medical professionals to ensure transparency.
SIRA's focus is on whether the injury meets the 'only injuries' test under the Act. If your hearing loss is the sole injury, benefits may be limited after 52 weeks, as outlined in s 4.4 of the Motor Accident Injuries Act 2017.
Practical Steps to Prepare for Medical Assessments
To ensure your claim is evaluated fairly, take these steps:
- Seek immediate medical attention to document symptoms and injuries. Delaying care can weaken your case.
- Request a full audiogram and any other tests required to assess the extent of your hearing loss.
- Keep records of all medical interactions, including dates, diagnoses, and treatment plans.
- Prepare a list of symptoms and how the injury affects your daily life, such as difficulty hearing conversations or using phones.
- Arrange for a specialist referral if your general practitioner cannot provide the necessary evidence.
In regional NSW, consider using telehealth services or contacting SIRA's regional offices for guidance on accessing specialists.
Time Limits and Disputes
The CTP scheme has strict time limits. You must notify your insurer within 28 days of the accident, and claims must be submitted within five years of the incident. Delays can result in denied benefits or reduced compensation.
If your claim is disputed, SIRA will review it based on the evidence. If you disagree with the outcome, you may need to:
- Request a review through the NSW Civil and Administrative Tribunal (NCAT).
- Seek independent medical advice to challenge the assessment.
When to Seek Legal Advice
While this article provides general guidance, your circumstances may require tailored advice. A solicitor can:
- Help you understand your entitlements under the CTP scheme.
- Ensure your medical evidence meets SIRA's standards.
- Navigate disputes or delays in processing your claim.
If you're unsure whether your claim meets the criteria, consult a lawyer before deadlines expire.
Final Steps for Claimants
Preparing for a medical assessment involves gathering detailed evidence, understanding SIRA's requirements, and acting promptly. If you're in regional NSW, consider using online resources or contacting SIRA directly for support. Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.