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).
Insurers assess liability for Motor Accident Compensation (MAC) Act legacy claims on the Central Coast by applying the rules from the now-repealed MAC Act. This framework determines whether a claim is valid, how much compensation is owed, and whether the injured person’s actions contributed to the accident. Understanding these factors is critical for claimants seeking compensation under the old scheme.
Key factors insurers evaluate
Insurers evaluate liability by considering:
- Fault: Whether the accident was caused by another driver’s negligence or breach of duty. Fault does not need to be 100% proven, but must be sufficiently established.
- Contributory fault: If the injured person contributed to the accident (e.g., distracted driving), compensation may be reduced proportionally.
- Nature of injury: Claims under the MAC Act are limited to injuries meeting the 'threshold injury' definition in the Motor Accident Guidelines. Severe injuries like spinal cord damage or brain trauma fall outside this scope.
- Timing of claim: Claims must typically be made within 3 years of the accident, though exceptions exist for minors or specific circumstances.
How Central Coast CTP administration affects claims
While all NSW CTP claims are administered by SIRA, the Central Coast has its own local office handling claims. Insurers must follow SIRA’s guidelines for legacy claims, including:
- Using the MAC Act’s 'no-fault' liability rules for most claims
- Applying the 52-week limit for weekly benefits and treatment costs when only threshold injuries are involved
- Adhering to strict evidentiary standards for proving contributory fault
Documentation required for legacy claims
To support a MAC Act claim, claimants must provide:
- Police reports confirming the accident and fault
- Medical records showing injuries meet the threshold definition
- Witness statements or CCTV footage
- Proof of income to calculate weekly benefits
- Correspondence with insurers showing timely claim submission
Time limits and dispute resolution
Claims under the MAC Act must be filed within 3 years of the accident. If an insurer disputes liability, claimants can:
- Request a review by SIRA’s Motor Accident Claims Unit
- Seek independent medical opinions to challenge the insurer’s injury assessment
- Lodge a complaint with the NSW Civil and Administrative Tribunal (NCAT) if a dispute escalates
When to seek legal advice
Legacy claims can be complex, especially when:
- The injury overlaps with threshold and non-threshold injuries
- The claimant has a history of prior claims
- The accident involved multiple parties or jurisdictions
- The insurer refuses to acknowledge liability
Understanding how insurers apply the MAC Act’s rules is essential for claimants on the Central Coast. While the scheme has been replaced by the Motor Accident Injuries Act 2017, legacy claims still require careful assessment of fault, injury type, and timing. Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.