What is a MAC Act legacy claim in NSW?
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).
Motor accident compensation claims in New South Wales that arose before 1 December 2017 are governed by the Motor Accidents Compensation Act 1999 (MACA), commonly referred to as the MAC Act. These are known as legacy claims. If you were injured in a motor accident in Greater Sydney on or before that date, your claim is assessed under the MACA framework, not the current Motor Accident Injuries Act 2017 (MAIA). This distinction is critical because the rules for compensation, entitlements and insurer decision-making differ significantly between the two schemes.
How insurers assess legacy claims under the MAC Act
Insurers assess MAC Act legacy claims based on a range of factors, including the nature and severity of injuries, the impact on your capacity to work, and the extent of financial loss. Unlike the current MAIA scheme, which uses a threshold injury system and a 52-week limit on benefits for certain injuries, the MACA framework allows for broader entitlements to damages and weekly payments, particularly where injuries are not classified as threshold injuries.
Insurers consider medical evidence, including reports from treating practitioners and independent medical assessors, to determine whether injuries are permanent and whether they have caused a loss of earning capacity. They also review records of treatment, time off work, and any changes in your ability to perform daily activities. The insurer’s decision will be based on whether the injury is considered serious, permanent, or likely to result in a long-term or permanent impact on your life.
What factors influence compensation decisions in Greater Sydney
In Greater Sydney, insurers apply the MACA framework consistently across the region, but local factors may affect how claims are processed. These include:
- The nature and severity of injuries, particularly if they involve permanent impairment, spinal injury, or significant psychological injury.
- Evidence of loss of income, including payslips, tax returns, and employer statements.
- Medical reports that detail the diagnosis, treatment, prognosis, and any permanent functional limitations.
- Whether the injury resulted in a permanent impairment, as assessed by a qualified medical practitioner using the Australian Medical Association (AMA) Guides to the Assessment of Permanent Impairment.
Insurers may also assess whether you contributed to the accident through your own negligence, which can reduce the amount of compensation awarded under the principle of contributory fault.
Practical steps if your insurer denies or disputes a claim
If your insurer denies a claim or disputes the amount of compensation, you have several options. First, ensure you have all relevant documentation, including:
- A copy of the police report or accident statement.
- Medical records and treatment notes from your treating practitioner.
- A record of time off work and any financial loss.
- Independent medical reports, if obtained.
If you disagree with the insurer’s decision, you may request a review of the decision. Insurers are required to provide a written explanation for their decision, including the reasons and the evidence relied upon. You can then appeal to the State Insurance Regulatory Authority (SIRA) for a review of the decision. SIRA has the authority to determine whether the insurer’s decision was correct under the MACA.
Time limits and procedural requirements
There are time limits for making a claim under the MACA. Generally, you must start legal proceedings within three years of the accident date. However, if you were under 18 at the time of the accident, the time limit extends to three years after your 18th birthday.
If you have not received a decision on your claim within a reasonable time, or if you believe the insurer has not properly considered your evidence, you may seek assistance from a legal practitioner who specialises in motor accident claims under the MACA.
When to seek independent advice
Given the complexity of legacy claims and the potential for disputes over medical assessments, financial loss, or the extent of permanent impairment, it is prudent to seek independent legal advice if:
- Your claim has been denied or partially accepted.
- The insurer disputes the extent of your injury or impairment.
- You believe the compensation offer does not reflect the full impact of your injury.
A qualified legal practitioner can help you understand your rights under the MACA, review the insurer’s assessment, and assist in preparing a formal appeal to SIRA if necessary.
Hypothetical example: A claim in Greater Sydney
Consider a 42-year-old office worker who was injured in a car crash in Sydney’s eastern suburbs on 15 March 2016. The accident resulted in a spinal injury with permanent neurological symptoms, including chronic pain and reduced mobility. The worker was off work for 18 months and has since returned to part-time duties with a reduced income. The insurer initially offered a settlement based on a lower impairment rating and limited weekly payments. After obtaining an independent medical report confirming a 20% whole person impairment and ongoing loss of earning capacity, the claimant challenged the insurer’s decision. SIRA later upheld the higher impairment rating and increased the compensation amount, reflecting the long-term impact of the injury.
Next steps
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.