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 been in a hit-and-run accident involving an unidentified vehicle in New South Wales, understanding how insurers assess your claim is critical. Under the Motor Accident Injuries Act 2017 (MAIA), insurers must evaluate claims based on the nature of injuries, medical evidence, and whether the accident meets the legal threshold for compensation. This article explains the practical steps for claimants, how insurers apply SIRA guidelines, and the legal boundaries of their decisions.
What to Do After a Hit-and-Run Accident
After a hit-and-run, your first priority is safety. Seek immediate medical attention even if injuries seem minor, as some soft-tissue injuries may not show symptoms immediately. Document the accident by taking photos of the scene, noting vehicle details (if visible), and collecting witness contact information. Report the incident to NSW Police and notify the CTP insurer of the claim. Failing to act quickly may affect your ability to claim benefits.
How Insurers Assess Claims
NSW insurers evaluate claims based on the Motor Accident Guidelines and SIRA’s published criteria. Key factors include:
- Nature of injuries: Claims for soft-tissue injuries (e.g., whiplash) are eligible for treatment and care benefits under the CTP scheme. However, insurers must determine if the injury meets the 'threshold injury' definition under the MAIA. This requires clinical evidence, such as medical reports confirming neurological signs or radiculopathy.
- Medical evidence: Insurers rely on medical practitioners to assess injuries. If your doctor documents a spinal nerve-root injury with neurological signs, it may qualify as a threshold injury. However, injuries limited to back pain without clinical signs may not meet the threshold.
- Time limits: If your injuries are limited to threshold injuries, weekly benefits and treatment benefits generally stop after 52 weeks. This is a statutory restriction under s 4.4 of the MAIA. Insurers must apply this rule unless the injury involves whole-person impairment (WPI) or long-term consequences.
SIRA’s Role in Determining Compensation
SIRA (State Insurance Regulatory Authority) provides authoritative guidance on what claimants can expect. For example, under the 'What you can claim' guidelines, claimants may receive:
- Treatment and care benefits for injuries requiring medical attention.
- Weekly income payments if the injury prevents work for 52 weeks or more.
- Lump sum payments for injuries with a whole-person impairment rating of 10% or more.
Insurers must apply these benefits consistently, but claimants should be aware that SIRA’s guidelines are not binding on insurers. Disputes may arise if an insurer denies a claim based on a narrow interpretation of the guidelines.
Practical Example: A Claimant’s Perspective
Consider a claimant who was hit by an unidentified vehicle and suffered a soft-tissue injury. Their doctor documents neck pain and tingling in the arms, which SIRA classifies as a threshold injury. The insurer may approve treatment benefits but stop payments after 52 weeks, citing the statutory limit. If the claimant believes the injury meets the threshold, they may need to seek a second medical opinion to challenge the insurer’s decision.
Time Limits and Disputes
Claimants must notify the CTP insurer within 52 weeks of the accident to claim weekly benefits. If the insurer denies a claim, you can request a review or seek independent legal advice. However, the 52-week period for benefits is strict, and delays may result in losing entitlements.
When to Seek Legal Advice
If an insurer denies your claim or stops benefits after 52 weeks, it’s important to consult a solicitor. They can review your medical records, assess whether your injury meets the threshold, and challenge the insurer’s decision based on the MAIA and SIRA guidelines. Legal advice is also recommended if you believe the insurer has misinterpreted the guidelines or failed to consider all evidence.
Next Steps
Understanding how insurers assess claims in hit-and-run cases requires careful attention to medical evidence, legal definitions, and time limits. If you’re unsure whether your claim meets the criteria, complete the quick, no obligation enquiry form to request contact about your circumstances. Every claim depends on its own facts, and the right legal guidance can help you navigate the process effectively.