Insurers in Newcastle and Hunter assess liability for CTP lump sum settlements by evaluating medical evidence, injury severity, and claimant circumstances under the Motor Accident Injuries Act 2017 (MAIA). This article explains the practical process insurers use to determine settlement offers, the factors they consider, and steps claimants can take if they disagree with an assessment.
Key Factors in Liability Assessments
Insurers evaluate liability by considering:
- Medical evidence: Detailed reports from medical practitioners confirming injuries, treatment history, and recovery progress.
- Injury severity: Whether the injury meets the MAIA's threshold injury definition, including spinal nerve-root injuries with neurological signs.
- Claimant circumstances: Income, dependants, and long-term impacts on daily life.
- Accident details: Police reports, witness statements, and vehicle information to establish fault.
Under the MAIA, insurers must assess whether injuries qualify as 'threshold injuries' (soft tissue injuries with neurological signs) or more severe impairments. For threshold injuries, weekly benefits and treatment payments generally stop after 52 weeks, affecting lump sum calculations.
Regional Process Differences
While the MAIA applies statewide, insurers in Newcastle and Hunter may have local practices influenced by:
- Higher claim volumes in busy areas like Newcastle CBD or M1 Motorway.
- Regional SIRA office guidelines for assessing injuries.
- Local legal precedents from NSW courts.
Insurers in these regions often use SIRA's Motor Accident Guidelines to evaluate injuries, ensuring consistency with state-wide rules. However, claimants should note that regional offices may have varying interpretations of evidence.
Steps if You Disagree with an Assessment
If you believe an insurer's liability assessment is unfair, take these steps:
- Request a detailed explanation of how the insurer reached its decision.
- Gather additional evidence such as second medical opinions or expert reports.
- Submit a formal dispute through the insurer's internal review process.
- Seek independent legal advice if the dispute escalates.
Claimants should act promptly, as time limits apply to certain benefits. For example, weekly income payments under the MAIA stop after 52 weeks if only threshold injuries are present. Disputing an offer after this period may limit recovery options.
Example Scenario
Consider a cyclist injured in a Newcastle car accident. The insurer assesses:
- Medical records showing a soft tissue injury with radiculopathy (confirmed by a neurologist).
- Police reports indicating the driver was at fault.
- The claimant's income and dependants.
The insurer may offer a lump sum based on the injury's severity and the claimant's circumstances. If the claimant believes the offer undervalues their injury, they can request a review or seek legal advice.
When to Seek Legal Advice
Consult a solicitor if:
- You disagree with the insurer's assessment of your injury.
- You need help navigating the claims process.
- You want to challenge a decision to stop benefits.
Legal professionals can help you understand your rights under the MAIA and ensure insurers follow the correct process.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.