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).
Lumbar disc herniation injuries are covered under NSW Compulsory Third Party (CTP) claims if they meet the threshold injury definition. This article explains how SIRA evaluates these injuries, what evidence is needed, and how to handle disputes. It also outlines time limits and practical steps for injured people in NSW.
What Injuries Are Covered Under NSW CTP Claims?
NSW CTP insurance covers injuries resulting from motor vehicle accidents, including lumbar disc herniation. However, the injury must meet the 'threshold injury' definition in the Motor Accident Injuries Act 2017. This includes injuries that cause persistent pain, limited mobility, or require medical treatment. SIRA assesses whether the injury falls within this category based on medical evidence.
How Do Insurers Assess Severity of Lumbar Disc Herniation Claims?
Insurers evaluate the severity of lumbar disc herniation claims using the Motor Accident Guidelines. Key factors include:
- Medical reports confirming the injury's cause and impact
- Evidence of ongoing pain or functional limitation
- Whether the injury meets the spinal nerve-root qualification (neurological signs beyond radiculopathy)
- The presence of whole person impairment (WPI) if the injury exceeds threshold level
What Evidence Is Needed for a Lumbar Injury Claim?
To support a lumbar disc herniation claim, injured people must provide:
- Detailed medical records from a registered medical practitioner
- A diagnosis of lumbar disc herniation confirmed by imaging (e.g. MRI)
- Evidence of how the injury affects daily activities
- Accident reports and witness statements where available
- Proof of income loss or medical expenses
How Does SIRA Handle Disputes Over Lumbar Injuries?
SIRA may dispute claims if they believe the injury does not meet threshold criteria. In such cases, injured people can:
- Request a review of the assessment
- Seek independent medical opinions
- Appeal to the NSW Civil and Administrative Tribunal (NCAT)
Time Limits and Practical Steps
CTP claims must be made within 52 weeks of the accident if the injury is a 'threshold injury'. For non-threshold injuries, claims can be made within 10 years. Injured people should:
- Seek immediate medical attention to document the injury
- Keep all medical records and correspondence
- Notify their insurer within the required timeframe
- Consider legal advice if disputes arise
When to Seek Independent Legal Advice
Injured people should consult a solicitor if:
- Their claim is rejected or delayed
- They face disputes over injury severity
- They need help navigating SIRA's assessment process
- They have questions about long-term benefits or WPI calculations
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.