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 your CTP claim was denied after 2017, the reforms to NSW's motor accident compensation system may have shifted how insurers assess and reject claims. This article explains key changes to the legal framework, how insurers now handle denials, and practical steps for regional claimants.
Key Changes to NSW CTP Rules Post-2017
The 2017 reforms restructured how insurers evaluate claims under the Motor Accident Injuries Act 2017. Notable shifts include:
- Stricter thresholds for benefits: Insurers now apply the 'threshold injury' definition more rigorously, requiring specific clinical signs for soft-tissue injuries (e.g., spinal nerve-root injuries with neurological signs). This has led to more denials of minor injuries.
- Limited weekly benefits after 52 weeks: If your injuries are classified as threshold-only, weekly income payments and treatment benefits stop after 52 weeks, even if recovery is incomplete.
- Greater emphasis on 'only injuries': Insurers must now prove your injuries are 'threshold-only' to deny benefits, which has raised the bar for claim rejections.
How Regional Claimants Are Affected
Regional NSW claimants may face additional hurdles. Insurers often have fewer claims handlers in rural areas, leading to:
- Longer delays in processing claims due to resource constraints.
- Higher reliance on automated systems for initial assessments, which may lack nuance for complex cases.
- Limited access to legal advice compared to metropolitan areas, making it harder to challenge denials.
Practical Steps to Challenge a Denied Claim
If your claim was denied, take these actions:
- Review the denial letter for specific reasons (e.g., 'injuries do not meet threshold criteria').
- Gather medical evidence showing your injuries match the threshold definition, including clinical notes and imaging.
- Submit a formal dispute to the insurer within 28 days of the denial, referencing the Motor Accident Guidelines.
- Seek independent medical opinion if the insurer's assessment conflicts with your treating doctor's records.
Time Limits and Dispute Options
You have 28 days to dispute a claim denial under the Motor Accident Injuries Act 2017. If the insurer refuses to reconsider, you may:
- Escalate to SIRA (State Insurance Regulatory Authority) for mediation.
- Apply to the NSW Civil and Administrative Tribunal (NCAT) for a review of the insurer's decision.
Example: A Regional Claimant's Experience
Consider a regional cyclist who suffered a soft-tissue injury after a collision. The insurer denied benefits, arguing the injury did not meet the threshold. The claimant challenged this by:
- Providing MRI scans showing spinal nerve-root involvement.
- Demonstrating the injury caused ongoing pain and reduced mobility.
- Filing a dispute within the 28-day window.
This led to a reassessment and eventual approval of benefits.
When to Seek Legal Advice
If your claim was denied and you:
- Cannot resolve the dispute with the insurer.
- Face a time limit for lodging a review.
- Need help interpreting medical or legal requirements.
Consult a solicitor experienced in regional CTP claims. While legal advice is not guaranteed, the reforms have made it easier for claimants to challenge denials through formal processes.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.