Understanding MAI Act Transitional Claims in NSW
A motor accident that occurred before 1 March 2017 may be subject to the Motor Accident Injuries Act 2017 (MAI Act) if the claim is still active or unresolved under the transitional provisions. This applies to residents of Auburn and other parts of NSW who have injuries that have not fully resolved, or who are still receiving treatment or benefits under the old CTP scheme. These are known as MAI Act transitional claims. The transitional framework allows for claims to be managed under the new law even if the accident happened under the old system, provided the claim was not finalised before the new law took effect.
Dispute Resolution Options Under the MAI Act
When a dispute arises over a transitional claim, such as a disagreement about the level of weekly income payments, treatment and care benefits, or eligibility for damages, there are several formal dispute resolution options available under NSW law. The primary process is internal review by the insurer, which must be requested within 28 days of receiving a decision. If the internal review does not resolve the dispute, the claimant may apply to the Personal Injury Commission (PIC) for a determination. The PIC is the independent body responsible for resolving disputes about CTP claims in NSW, including transitional claims.
For disputes involving medical evidence, such as disagreement over the extent of whole person impairment (WPI) or the need for ongoing treatment, the PIC may require a medical assessment under the Motor Accident Injuries (Medical Assessment) Regulation 2017. This process ensures that decisions are based on independent medical opinion, not just insurer assessment.
Key Differences in Resolving Transitional Claims
Transitional claims differ from standard CTP claims in how benefits are calculated and when they may be limited. Under the MAI Act, if a person’s only injuries are threshold injuries (such as soft tissue injuries), weekly benefits and treatment and care benefits are generally limited to 52 weeks from the date of the accident. This 52-week rule applies even if the injury is still affecting the claimant, unless the injury is not a threshold injury or a higher threshold is met.
In contrast, claims that are not transitional, where the accident occurred on or after 1 March 2017, are governed by the full MAI Act framework from the outset. Transitional claimants may not have access to the same procedural rights or benefit caps as those under the new law, depending on when the claim was initiated and whether a final decision was made under the old scheme.
Practical Steps and Evidence That Matter
To resolve a dispute, claimants should gather and preserve the following evidence:
- Medical records from the treating practitioner, including assessments of injury, treatment progress, and any recommendations for ongoing care.
- A copy of the insurer’s decision letter, including the reason for denial or reduction of benefits.
- Photographs of the accident scene, vehicle damage, or injury symptoms, if available.
- Witness statements, if any.
- Pay slips or proof of lost income, if claiming weekly payments.
- Correspondence with the insurer, including emails and letters.
A claimant must apply for internal review within 28 days of receiving a decision. Missing this deadline may prevent access to further dispute resolution. The PIC must issue a determination within 60 days of receiving a dispute application, unless an extension is granted.
Hypothetical Example: A Claim in Auburn
A resident of Auburn was involved in a motor vehicle accident on 15 February 2016. They sustained a whiplash injury and have been receiving treatment since. In 2023, the insurer reduced their weekly income payment, citing that the injury was a threshold injury and that benefits should end after 52 weeks. The claimant believes the injury has not resolved and that they still experience pain and functional limitations. They have medical reports showing ongoing symptoms and a WPI assessment of 12%. The claimant has not yet requested an internal review. In this case, the next step is to request internal review within 28 days, and if unresolved, to apply to the Personal Injury Commission for a determination.
When to Seek Independent Advice
A dispute does not guarantee a change in decision. The insurer may have valid grounds for its position, and the PIC will assess all evidence before making a determination. However, if a claimant believes the insurer has not properly considered medical evidence, or if the decision appears to conflict with the Motor Accident Injuries (Medical Assessment) Regulation 2017, independent legal advice may be helpful. The claimant should not alter, destroy or withhold evidence. The PIC may order a medical assessment if it determines that the evidence is insufficient or conflicting.
Next Steps for Auburn Residents
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.