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 your CTP claim has been denied by an insurer in Illawarra or the South Coast, you need to understand what evidence supports your injury. Under NSW law, claimants must prove the injury's existence, its connection to the accident, and its impact on daily life. This checklist, based on SIRA guidelines, outlines critical documentation to challenge a denial.
What Evidence Matters for CTP Claims
CTP insurers must pay for injuries caused by motor vehicles under the Motor Accident Injuries Act 2017. To dispute a denial, you must demonstrate:
- Medical evidence of the injury (e.g., GP notes, specialist reports, imaging)
- Accident details (e.g., police report, witness statements, photos of the scene)
- Impact on daily life (e.g., medical certificates, employment records, care records)
SIRA's guidelines stress that injuries must be 'reasonably foreseeable' from the accident. For example, if you suffered a soft-tissue injury requiring physiotherapy, medical records must show this link.
Key Documentation to Gather
- Medical records showing the injury's diagnosis, treatment, and prognosis
- Accident report from the police or insurer (if available)
- Witness statements from people who saw the accident
- Photographs of the accident scene, vehicle damage, and your injuries
- Employment or income records to show lost wages or reduced capacity
- Communication with the insurer (e.g., claim forms, correspondence)
If your injury involves a 'threshold injury' (e.g., whiplash), SIRA requires specific clinical signs like neurological symptoms. Ensure your medical team documents these.
How to Challenge a Denial
If your claim is denied, you can:
- Request a review with the insurer, citing missing evidence
- Seek independent medical assessment if the insurer disputes your injury's severity
- Apply to the NSW Civil and Administrative Tribunal (NCAT) if the insurer refuses to reconsider
Note: Time limits apply. Most CTP claims must be submitted within 52 weeks of the accident, though exceptions exist for ongoing injuries.
When to Seek Legal Advice
If the insurer refuses to pay for documented injuries, or if you're unsure about your evidence, contact a solicitor. Legal professionals can:
- Help you understand SIRA's 'only injuries' rule (where threshold injuries stop paying after 52 weeks)
- Challenge incorrect assessments of your injury's severity
- Navigate disputes over medical evidence
Example Scenario
A cyclist in Wollongong was denied a CTP claim for a soft-tissue injury. Their GP documented neck pain and restricted activity, but the insurer argued there was no 'neurological sign'. After a specialist confirmed radiculopathy (a clinical sign under SIRA guidelines), the claim was approved. This shows how precise medical documentation can overturn a denial.
Next Steps
CTP claim outcomes depend on the accident date, injury type, and evidence quality. If you're in Illawarra or the South Coast and need help with a denied claim, complete the quick, no obligation enquiry form to request contact about your circumstances.