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 you've received a lump sum settlement offer from the NSW Compulsory Third Party (CTP) scheme and believe it's unfair, you have legal options to challenge it. This article explains how to dispute a CTP lump sum offer, how the State Insurance Regulatory Authority (SIRA) handles such disputes, and practical steps to take. It also covers alternative resolution options and time limits for action.
Legal Framework for Disputing CTP Lump Sum Offers
Under the Motor Accident Injuries Act 2017, CTP insurers must offer lump sum settlements based on medical evidence and injury assessments. If you disagree with the offer, you can challenge it by showing the settlement fails to account for all your losses. SIRA oversees these disputes and ensures claims align with the Motor Accident Guidelines.
Key considerations include:
- Threshold injuries: If your injury meets the 'threshold injury' definition in the guidelines, the offer may be limited to statutory benefits.
- Whole person impairment (WPI): For severe injuries, WPI assessments determine lump sum amounts. Disputes often arise if the WPI rating is contested.
- Statutory benefits cap: After 52 weeks, weekly payments and treatment benefits stop unless you have non-threshold injuries.
Practical Steps to Challenge a CTP Lump Sum Offer
- Review the offer details: Check if the settlement accounts for all injuries, lost income, and future care needs. Compare it to the Motor Accident Guidelines.
- Gather medical evidence: Obtain updated medical records, treatment plans, and expert opinions to support your claim. SIRA requires clinical evidence to assess injury severity.
- Contact SIRA: Submit a written objection to the CTP insurer through SIRA. You can request a review of the settlement calculation or ask for a reassessment of your injury.
- Seek independent medical advice: A specialist report from a registered medical practitioner may be needed to challenge the initial assessment.
Alternative Dispute Resolution Options
SIRA offers mediation as a first step to resolve disputes. If mediation fails, you may:
- Request an internal review: SIRA can review the decision if new evidence emerges or if there's a procedural error.
- Appeal to the NSW Civil and Administrative Tribunal (NCAT): You can apply for a review of the CTP insurer's decision within 28 days of receiving the offer.
- Take legal action: In rare cases, a claimant may pursue a court challenge, though this is uncommon and typically reserved for systemic errors.
Time Limits and When to Seek Advice
You have 28 days to request a review of a CTP insurer's decision. If you miss this deadline, you may lose the right to challenge the offer. For disputes over lump sum amounts, you can apply for a review at any time, but delays can reduce your chances of success.
If you're unsure whether your claim meets the criteria for a dispute, seek legal advice promptly. A solicitor can help you assess whether your injury qualifies for a higher settlement and whether you've met all procedural deadlines.
Example: Disputing a Threshold Injury Offer
Consider a scenario where a pedestrian is hit and suffers a soft-tissue injury. The CTP insurer offers a lump sum based on the threshold injury guidelines. The claimant may dispute the offer if:
- The injury requires ongoing treatment not accounted for in the offer.
- The claimant has additional injuries (e.g., a back strain) not identified in the initial assessment.
- The settlement fails to reflect the full impact of the injury on daily life.
In such cases, providing updated medical evidence and a detailed explanation of how the offer understates losses is critical.
Next Steps
CTP lump sum disputes depend on the date of the accident, the nature of the injury, and whether the offer reflects all losses. To request contact about your circumstances, complete the quick, no obligation enquiry form.