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 rejected or partially approved, you may request an internal review before escalating to the Personal Injury Commission (PIC) or the State Insurance Regulatory Authority (SIRA). This guide explains the practical steps for injured road users in Newcastle and Hunter to challenge CTP claim decisions under NSW law.
NSW CTP Rules Behind the Question
New South Wales' Compulsory Third Party (CTP) scheme governs motor accident compensation. Insurers must consider claims under the Motor Accident Injuries Act 2017 and the Motor Accident Guidelines. If an insurer denies or limits benefits, claimants can request an internal review to challenge the decision.
Practical Steps and Evidence That Usually Matter
To request an internal review, you must:
- Submit a written request to the insurer within 28 days of receiving the decision (s 4.4 of the Motor Accident Injuries Act 2017)
- Include medical evidence showing your injury meets the 'threshold injury' definition in the Motor Accident Guidelines
- Provide accident reports, witness statements, and medical records
- Reference SIRA's guidance on what you can claim (https://www.sira.nsw.gov.au/claims/motor-accidents/what-you-can-claim)
Insurers in Newcastle and Hunter typically review claims by:
- Reassessing medical reports against the Motor Accident Guidelines
- Checking for contributory fault or threshold injury criteria
- Considering the 52-week statutory benefit period for weekly income payments
Time Limits, Disputes and When to Seek Advice
You must request an internal review within 28 days of the insurer's decision. If the review outcome is unsatisfactory, you can escalate to the PIC or SIRA within 21 days of the review decision.
Disputes often arise over:
- Whether the injury meets the threshold injury definition
- The calculation of weekly income payments
- The duration of treatment and care benefits
Seek legal advice if:
- The insurer refuses to review your claim
- You receive a 'no claim' decision despite medical evidence
- You need to challenge the insurer's interpretation of the Motor Accident Guidelines
Hypothetical Example
A cyclist in Newcastle suffered a soft-tissue injury after a car accident. The insurer denied weekly income payments, arguing the injury did not meet the threshold injury definition. The claimant requested an internal review, providing MRI scans showing spinal nerve-root injury with neurological signs. The insurer reconsidered and approved benefits after reviewing SIRA's guidance.
Next Steps
CTP claim decisions depend on the accident date, injury type, and insurer interpretation. To request contact about your circumstances, complete the quick, no obligation enquiry form.