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).
If you've received a lump sum settlement offer under NSW's Compulsory Third Party (CTP) scheme and are required to undergo medical assessments, you need to understand how insurers evaluate your claim. This article explains the legal process, what to expect, and practical steps to prepare for assessments in Bankstown.
What Happens When You Receive a Lump Sum Offer?
After a motor accident, insurers may offer a lump sum settlement based on your injuries. However, this offer often requires medical assessments to confirm the extent of your injuries and their connection to the accident. These assessments are critical because they determine whether your claim meets the criteria for compensation under the Motor Accident Injuries Act 2017.
Insurers use medical assessments to:
- Verify that your injuries fall within the 'threshold injury' definition (soft tissue injuries with neurological signs)
- Determine if your injuries qualify for long-term benefits like weekly income payments
- Assess whether your injuries meet the 'whole person impairment' threshold for damages
Preparing for Medical Assessments in NSW
To prepare effectively, you should:
- Gather all medical records related to your injuries, including pre-accident health history
- Document all treatment details, including consultations, scans, and prescribed medications
- Bring a list of all symptoms and how they affect your daily life
- Prepare questions for the assessor about how your injuries will be evaluated
It's important to note that insurers may use the results of these assessments to reduce or deny your claim. For example, if your injuries are found to be below the threshold, you may lose access to certain benefits after 52 weeks under the Act.
What to Expect During Assessments
Medical assessments typically involve:
- A physical examination by a registered medical practitioner
- Review of your medical history and treatment records
- Questions about your symptoms and how they impact your ability to work or perform daily activities
The assessor will look for clinical signs that meet the Motor Accident Guidelines, such as spinal nerve-root injuries or radiculopathy. If your injuries don't meet these criteria, your claim may be limited to short-term benefits.
Time Limits and When to Seek Advice
You have 52 weeks from the date of your accident to claim certain benefits under the CTP scheme. After this period, weekly income payments and treatment benefits are generally limited unless your injuries meet the whole person impairment threshold. If you're unsure whether your injuries qualify, seek legal advice before the 52-week period expires.
Example: How Assessments Affect Settlement Offers
Consider a scenario where a driver in Bankstown receives a lump sum offer after a minor collision. The insurer requests a medical assessment to confirm the driver's injuries are below the threshold. If the assessment shows no neurological signs, the driver may lose access to long-term benefits, even if their injuries are painful. This highlights why it's crucial to understand how assessments are conducted and what evidence is required.
Next Steps
If you're preparing for a medical assessment and unsure how to proceed, seek guidance from a legal professional familiar with NSW CTP claims. General information cannot determine whether a claim is available in an individual case. Time limits and procedural requirements may apply. To request contact about your circumstances, complete the quick, no obligation enquiry form.