What the PIC Looks For in Hearing Loss Disputes
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 acoustic trauma in a motor accident in Ballina, the Prescribed Independent Claimant (PIC) assesses whether your injury meets NSW CTP scheme criteria. The PIC evaluates medical evidence to determine if your injury qualifies as a 'threshold injury' under the Motor Accident Injuries Act 2017. Key factors include whether the injury resulted from the accident and if it meets the clinical signs outlined in the Motor Accident Guidelines.
NSW CTP Rules for Hearing Loss Claims
Under the CTP scheme, hearing loss caused by acoustic trauma may qualify for treatment and care benefits, weekly income payments, or damages depending on the injury's severity. The PIC requires detailed medical records, including audiograms, to assess the injury's origin and extent. For example, if a car airbag caused a sudden hearing loss, the PIC will check if the injury aligns with the guidelines' definition of acoustic trauma.
Evidence and Practical Steps for Disputes
To support your claim, gather: medical reports confirming the injury's date and cause, witness statements about the accident, and evidence of how the injury affects your daily life. If the PIC disputes your claim, you may need to provide additional expert opinions or clarify how the injury relates to the accident. For instance, if the PIC questions whether the hearing loss was pre-existing, medical records showing a sudden change post-accident are critical.
Time Limits and Dispute Resolution
You must notify the PIC of your claim within 52 weeks of the accident. If the PIC's assessment is disputed, you can request an internal review or escalate to the Personal Injury Commission. Note that challenges do not guarantee a changed decision; the PIC will re-evaluate evidence but must still apply the same legal standards.
When to Seek Legal Advice
If the PIC denies your claim or disputes the severity of your injury, consult a legal professional. They can help challenge the PIC's assessment, ensure all evidence is properly submitted, and explain how to navigate the CTP scheme's rules. Always act within the 52-week deadline to preserve your right to claim.