How to Resolve Disputes Over Transitional Claims Under the MAI Act 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).
If you're involved in a motor accident claim that spans the transition from the old Motor Accidents Compensation Act 1999 (MACA) to the current Motor Accident Injuries Act 2017 (MAIA), you may face unique dispute resolution challenges. Transitional claims involve injuries occurring before and after 1 December 2017, when NSW replaced the old CTP scheme with the new MAIA. This article explains how to resolve disputes under the MAI Act, focusing on SIRA's processes and key steps to take.
Understanding Transitional Claims Under the MAI Act
Transitional claims are governed by the MAI Act, which applies to accidents occurring on or after 1 December 2017. However, claims involving injuries that occurred before this date may also fall under the new scheme if the injury was not resolved under the old MACA. The key distinction is that the MAI Act replaces the MACA for all claims where the accident occurred on or after the transition date. This means disputes over transitional claims must be resolved under the MAI Act's framework, which includes specific rules about benefits, time limits, and dispute resolution.
SIRA's Role in Disputing Transitional Claims
The State Insurance Regulatory Authority (SIRA) administers claims under the MAI Act. If you dispute a decision about your transitional claim, SIRA provides several resolution pathways. First, you may request an internal review of the decision. If the issue remains unresolved, you can escalate the matter to the Personal Injury Commission (PIC), which oversees disputes under the MAI Act. The PIC has the authority to review claims, including medical assessments and benefit calculations, and may refer complex cases to the NSW Civil and Administrative Tribunal (NCAT) for further resolution.
Key Steps to Resolve a Transitional Claim Dispute
- Review the Decision: If SIRA denies or limits your claim, request a written explanation of the reasons. Transitional claims often involve complex calculations of benefits, so understanding the basis of the decision is critical.
- Internal Review: Submit a formal request for an internal review within 28 days of receiving the decision. This allows SIRA to reassess the claim based on new evidence or a different interpretation of the law.
- Escalate to the PIC: If the internal review does not resolve the dispute, you can apply to the PIC for a review. The PIC will examine the claim, including medical reports and evidence of injury, and may request additional information.
- Seek Legal Advice: If the PIC's decision is unsatisfactory, you may need to seek legal assistance to challenge the outcome in NCAT. Legal representation can help ensure your rights under the MAI Act are fully protected.
Practical Evidence for Transitional Claims
To support your dispute, gather and preserve evidence such as:
- Medical records showing the injury's date, severity, and ongoing impact.
- Accident reports from police or witnesses.
- Witness statements confirming the incident.
- Photographs of the accident scene.
- Correspondence with SIRA or insurers.
- Income records to demonstrate financial loss.
These documents are essential for proving the injury's date and showing how it falls within the transitional claim period. SIRA may dispute claims if evidence is incomplete or if the injury date is unclear.
A Hypothetical Example
Consider a claimant injured in a 2015 car accident under the old MACA scheme. After the injury was not resolved, they suffered a new injury in 2020. Under the MAI Act, the 2020 injury would fall under the new scheme. If SIRA disputes the claim, the PIC would assess whether the 2020 injury qualifies as a 'threshold injury' under the MAI Act. This requires medical evidence showing the injury meets the spinal nerve-root criteria in the Motor Accident Guidelines.
When to Seek Legal Advice
Disputes over transitional claims can be complex, especially when they involve overlapping periods under the old and new schemes. Legal advice is recommended if:
- The claim involves both pre- and post-2017 injuries.
- SIRA denies benefits for a threshold injury.
- The PIC's decision is not satisfactory.
A solicitor can help ensure your claim complies with the MAI Act and that all evidence is properly presented.
Next Steps for Claimants
Resolving a transitional claim dispute requires careful navigation of the MAI Act's rules. By understanding SIRA's processes, gathering strong evidence, and seeking legal advice when needed, you can better protect your rights. If you're unsure how to proceed, complete the quick, no obligation enquiry form to request contact about your circumstances.