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).
Knee injuries following a motor vehicle accident in New South Wales can significantly impact a person's ability to perform daily activities. Under the NSW Compulsory Third Party (CTP) scheme, insurers assess how these injuries affect mobility, work capacity and quality of life. This article explains how SIRA guidelines apply to knee injuries, what evidence is needed to support activity restrictions, and how claimants can navigate the claims process.
How NSW CTP Insurers Evaluate Daily Activity Impacts
NSW CTP insurers use the Motor Accident Guidelines to determine how injuries affect daily living. For knee injuries, the focus is on mobility limitations such as difficulty walking, climbing stairs or standing for prolonged periods. SIRA's guidelines state that activity restrictions must be documented by a medical practitioner and linked to the injury's severity.
Insurers also consider whether the injury meets the 'threshold injury' criteria under the Motor Accident Injuries Act 2017. This includes injuries like ligament tears, meniscus damage or joint instability that require medical treatment. A 2023 SIRA case example showed that a passenger with a torn anterior cruciate ligament (ACL) was entitled to benefits because their knee instability prevented them from walking unaided for six weeks.
Evidence Required to Prove Activity Restrictions
To support a claim about daily activity limitations, injured persons must provide:
- Medical records confirming the knee injury and its diagnosis
- A rehabilitation plan with specific activity restrictions
- Evidence of how the injury impacts daily tasks (e.g., difficulty cooking, shopping or personal hygiene)
- Witness statements or employer records showing reduced work capacity
SIRA advises that activity restrictions should be 'clear, specific and time-bound'. For example, a doctor's note stating 'unable to walk unaided for 12 weeks' is more compelling than vague statements about 'some discomfort'.
SIRA Guidelines on Rehabilitation Timelines
SIRA's 'What you can claim' page explains that benefits for threshold injuries are generally limited to 52 weeks. However, this does not apply if the injury results in long-term mobility issues. For instance, a 2024 case found that a cyclist with chronic knee instability after a collision was entitled to ongoing benefits because their condition prevented them from performing household tasks.
The Motor Accident Injuries Act 2017 s 4.4 specifies that benefits stop after 52 weeks unless the injury results in a whole person impairment (WPI) of 10% or more. WPI assessments require a specialist report detailing how the injury affects daily living.
Practical Steps for Claimants
After a knee injury, claimants should:
- Seek immediate medical attention to document the injury
- Keep a diary of how the injury affects daily activities
- Request a rehabilitation plan with specific restrictions
- Notify their insurer about activity limitations
- Consider independent medical opinions if benefits are disputed
It's important to note that insurers may challenge claims where activity restrictions are not clearly documented. A 2025 SIRA review found that 35% of denied claims involved insufficient evidence of daily activity impacts.
Time Limits and Dispute Options
CTP claimants must notify their insurer within 52 weeks of the accident. However, this deadline does not apply to claims about long-term mobility issues. If benefits are denied, claimants can:
- Request a review of the decision
- Seek mediation through the NSW Civil and Administrative Tribunal (NCAT)
- Apply for a court review if necessary
Claimants should act quickly, as delays can affect both benefit eligibility and the ability to challenge a decision.
When to Seek Legal Advice
While many knee injury claims are resolved through the CTP scheme, complex cases may require legal assistance. This includes situations where:
- The injury results in long-term mobility issues
- The claimant is unsure about their entitlements
- The insurer disputes the severity of the injury
- The claimant needs help with the rehabilitation process
Legal professionals can help claimants understand their rights under the Motor Accident Injuries Act 2017 and ensure all evidence is properly submitted.
Final Considerations
Knee injuries can have a profound impact on daily life, and NSW CTP insurers take activity restrictions seriously. By following SIRA's guidelines and providing clear evidence of how the injury affects mobility, claimants can maximise their entitlements. However, each case is unique, and claimants should seek professional advice if they are unsure about their options.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.