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 pre- and post-2017 CTP laws in New South Wales, understanding how to resolve disputes is critical. Transitional claims under the Motor Accident Injuries Act (MAI Act) require specific dispute resolution steps, especially in regional areas where access to legal resources may differ from metropolitan centres. This article explains the legal framework, practical steps, and regional considerations for resolving disputes over transitional claims.
NSW CTP Rules Behind Transitional Claims
Transitional claims arise when an accident occurred before 1 April 2017, but the injury is assessed under the new MAI Act. Under the Motor Accident Injuries Act 2017, claims must be resolved through a structured process that includes internal reviews, mediation, and tribunal referrals. Key principles include:
- Internal review timelines: Claimants must request an internal review within 28 days of receiving a decision. This applies to both statutory benefits and damages assessments.
- SIRA's role: The State Insurance Regulatory Authority (SIRA) oversees claims under the MAI Act. Disputes must first be escalated through SIRA's internal processes before external review.
- Regional access: In regional NSW, claimants may face longer wait times for SIRA reviews or limited access to legal advice. This can affect the timing of dispute resolution.
Practical Steps and Evidence for Disputes
To resolve a transitional claim dispute, you must:
- Gather evidence: Medical records, accident reports, witness statements, and correspondence with insurers are critical. For example, if a claimant disputes a 'threshold injury' assessment, detailed medical evidence must show neurological signs beyond radiculopathy.
- Request internal review: Submit a written request to SIRA within 28 days of the decision. This must include specific grounds for dispute, such as a disagreement with the injury classification.
- Seek independent medical opinion: If a claimant challenges a medical assessment, an independent report from a registered medical practitioner may be required. This is particularly important in regional areas where specialist services are limited.
Time Limits and Regional Considerations
Disputes must be resolved within strict timeframes. For example:
- Internal reviews: Must be completed within 28 days of the initial decision.
- Tribunal referrals: If a claimant disagrees with the internal review outcome, they must apply to the NSW Civil and Administrative Tribunal (NCAT) within 28 days of the review decision.
In regional NSW, delays in accessing legal advice or SIRA reviews can impact compliance with these deadlines. Claimants should seek assistance from local legal aid services or community legal centres to avoid procedural errors.
Example: Disputing a Threshold Injury Assessment
Consider a claimant who sustained a soft-tissue injury in a 2016 accident. Under the pre-2017 CTP scheme, they received benefits for a 'threshold injury.' When the claim was reassessed under the MAI Act, SIRA classified the injury as non-threshold. The claimant disputed this by providing MRI evidence of spinal nerve-root damage meeting the 2017 guidelines. After an internal review, SIRA revised the assessment, highlighting the importance of medical evidence in transitional disputes.
When to Seek Advice
Disputes over transitional claims can be complex, especially when involving:
- Medical disputes: Conflicts over injury classification or impairment ratings.
- Time-sensitive processes: Missing internal review deadlines can permanently bar a claim.
- Regional resource gaps: Limited access to legal experts or SIRA representatives in non-metro areas.
If you're facing a dispute, contact a local solicitor or legal aid organisation to ensure your rights under the MAI Act are protected. Every claim depends on its own facts.
Next Steps
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