Motor vehicle accidents involving merging traffic on NSW motorways, including major routes in Greater Sydney such as the M4, M5 and M8, can result in serious injuries. If you have been injured in such an incident, you may be entitled to compensation through the Compulsory Third Party (CTP) insurance scheme. This article explains how to prepare for medical assessments required under the CTP scheme, the role of the State Insurance Regulatory Authority (SIRA), and the practical steps you should take to support your claim.
The current legal framework for motor accident compensation in NSW is governed by the Motor Accident Injuries Act 2017 (MAIA). This law sets out the rules for claiming benefits, including treatment and care, weekly income payments, and damages. Your claim will be assessed under this framework, regardless of whether the accident occurred on a public road, a motorway, or a private access road used for public travel.
Medical assessments are a key part of the CTP claims process. These assessments are conducted by independent medical practitioners approved by SIRA to determine the nature and extent of your injuries. The results are used to assess your eligibility for benefits, including whether you have a threshold injury, and to determine your level of whole person impairment (WPI) if you are claiming damages.
To prepare for your medical assessment, you should gather and keep the following documents:
- A copy of the police report, if one was filed at the scene.
- Medical records from your treating practitioner, including all notes, test results, and treatment plans.
- A detailed diary of your symptoms, pain levels, and functional limitations since the accident.
- Records of any time off work, including a letter from your employer or a payslip showing reduced income.
- Photographs of the accident scene, vehicle damage, and any visible injuries.
- Contact details for any witnesses to the incident.
SIRA does not conduct medical assessments itself. Instead, it approves independent medical practitioners to perform assessments under the Motor Accident Injuries Regulation 2017. These assessments are used to determine whether you have sustained a threshold injury, which may affect your eligibility for damages. A threshold injury includes certain soft tissue injuries, but only if they meet the criteria set out in the Motor Accident Injuries Guidelines. For example, a spinal nerve-root injury that causes neurological signs such as muscle weakness or altered sensation may qualify, but radiculopathy (a type of nerve pain) requires specific clinical signs to be recognised under the Guidelines.
If you have been assessed as having only threshold injuries, the MAIA limits the duration of statutory benefits. Weekly income payments and treatment and care benefits are generally not payable after 52 weeks from the date of the accident, unless a review is conducted and a new determination is made. This 52-week rule applies only to claims where the only injuries sustained are threshold injuries.
You are not required to attend a medical assessment if you have not yet made a claim. However, if you have notified your insurer or SIRA of your intention to claim, you will be required to attend a scheduled assessment. Failure to attend without a valid reason may result in a delay or denial of benefits. You should notify your insurer or SIRA in writing if you are unable to attend due to medical reasons, and provide supporting medical evidence.
A common mistake is to assume that a medical assessment is only for determining damages. In fact, assessments are also used to confirm eligibility for treatment and care benefits, and to assess your capacity to return to work. It is important to be honest and thorough during the assessment. Do not exaggerate symptoms, but also do not understate your limitations. Your medical history, including pre-existing conditions, will be considered, but only injuries that arose from the accident will be taken into account for compensation purposes.
If you disagree with the outcome of a medical assessment, you may request a review. This can be done by contacting your insurer or SIRA directly. You may also seek a second opinion from a different medical practitioner, but this will not override the official assessment unless it is formally submitted through the review process.
A realistic example: A driver in Sydney was involved in a merge accident on the M5 in August 2024. They sustained a whiplash injury and were diagnosed with a cervical nerve-root injury showing signs of muscle weakness. After 50 weeks of treatment, they were assessed as having a threshold injury. Their insurer applied the 52-week limit and ceased weekly payments. The claimant provided a detailed diary and updated medical reports showing ongoing functional limitations. This evidence was used to request a review, which led to a reassessment and the continuation of benefits.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.