What the PIC Requires for 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).
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 due to acoustic trauma in a motor accident on the Central Coast, the Prescribed Injury Claimant (PIC) will assess your claim based on strict criteria. The PIC expects evidence that your injury meets the threshold injury definition under the Motor Accident Injuries Act 2017 and that the injury is directly caused by the accident. This includes medical documentation showing a connection between the trauma and your hearing loss.
NSW CTP Rules for Hearing Loss Claims
Under the NSW CTP scheme, injuries must be assessed against the Motor Accident Guidelines. For acoustic trauma-related hearing loss, the PIC will require:
- A diagnosis of a threshold injury (as defined in the guidelines)
- Evidence that the injury resulted from the accident (e.g., exposure to loud noises from a crash or airbag deployment)
- Medical records confirming the injury's impact on your hearing
The PIC will also consider whether your injury qualifies for statutory benefits under the 52-week statutory benefit period. If your injury is classified as a threshold injury, benefits may be limited after 52 weeks unless you meet the whole person impairment threshold.
Evidence Needed for Acoustic Trauma Claims
To support your claim, you'll need:
- Detailed medical records from an audiologist or ENT specialist
- Audiogram results showing hearing loss
- Expert opinion linking the injury to the accident
- Police reports or accident statements confirming the incident
- Witness statements if available
The PIC will scrutinise whether the injury meets the 'spinal nerve-root qualification' outlined in the Motor Accident Guidelines. For example, if your hearing loss is caused by damage to the auditory nerve, this must be documented by a medical practitioner.
How Disputes Over Hearing Loss Claims Work
If the PIC disputes your claim, they will typically request an internal review or refer the matter to the Personal Injury Commission (PIC) for further assessment. During disputes, the PIC may:
- Request additional medical evidence
- Compare your injury to the Motor Accident Guidelines
- Consider whether the injury meets the 'only injuries' criteria under s 4.4 of the Motor Accident Injuries Act 2017
It's important to note that disputes are not guaranteed to result in a changed decision. The PIC will assess whether the evidence meets the statutory threshold for benefits or damages.
Practical Steps for Central Coast Claimants
If you're on the Central Coast and disputing a CTP claim for hearing loss, take these steps:
- Obtain a full medical assessment from a specialist
- Request a copy of your audiogram and treatment records
- Submit all evidence to the PIC within the 52-week statutory benefit period
- Consider seeking independent medical advice if the PIC disputes your claim
Remember, the PIC will not pay for injuries that don't meet the threshold injury definition. If your claim is denied, you may need to pursue a common law damages claim through the courts, but this is only available if your injury meets the whole person impairment threshold.
When to Seek Legal Advice
If the PIC has denied your claim or is disputing the extent of your injury, it's important to seek legal advice. A solicitor can help you:
- Challenge the PIC's assessment of your injury
- Explore options for a common law damages claim
- Navigate the internal review process
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.