Understanding MAI Act Transitional Claims in NSW
Motor accident claims in rural and remote New South Wales that began under the old CTP system but are still active under the Motor Accident Injuries Act 2017 (MAI Act) are governed by transitional provisions. These claims arise when an accident occurred before 1 July 2017, but the injury or treatment continues into the new legal framework. The MAI Act introduced changes to entitlements, thresholds for damages, and the way benefits are accessed. For people in regional and remote areas, this transition can complicate claims due to limited access to medical specialists, delayed reporting, and challenges in preserving evidence.
SIRA, the State Insurance Regulatory Authority, administers the CTP scheme and provides guidance on how transitional claims are assessed. The key difference from standard CTP claims is that the law in force at the time of the accident may still apply to certain aspects of the claim, particularly if the injury was not fully resolved by 1 July 2017. This means that some claimants may still be eligible for benefits under the pre-2017 rules, while others fall under the new MAI Act framework.
How SIRA Assesses Transitional Claims in Remote Areas
SIRA applies a case-by-case approach to transitional claims, particularly in rural and remote NSW where access to medical and legal services is limited. The authority considers the date of the accident, the nature and duration of injuries, and the point at which treatment and care benefits were last accessed. For example, if a person was injured in a car crash in Wagga Wagga on 15 March 2016 and continues to experience chronic back pain requiring ongoing physiotherapy, SIRA will assess whether the claim is still subject to the old CTP rules or has moved into the MAI Act regime.
SIRA recognises that in remote areas, medical evidence may be delayed or incomplete. A claimant who was treated by a local general practitioner in Broken Hill may not have access to a specialist neurologist until months later. In such cases, SIRA allows for the submission of medical records, treatment notes, and a formal assessment of whole person impairment (WPI) to be completed by a qualified medical practitioner, even if the assessment occurs after 1 July 2017. The authority also accepts evidence from local emergency services, police reports, and witness statements, particularly where the accident occurred on a remote road with no traffic cameras.
Key Differences in Benefits and Evidence Requirements
Transitional claims differ from standard CTP claims in three main ways. First, the threshold for claiming damages has changed. Under the MAI Act, a claimant must have a threshold injury (such as a soft tissue injury with a WPI of 16% or more) to access damages. However, for claims that began before 1 July 2017, the old threshold may still apply if the injury was assessed under the previous rules. This means a claimant who was assessed as having a 15% WPI under the old system may still qualify for damages, even if the new threshold is 16%.
Second, treatment and care benefits are not automatically limited to 52 weeks for transitional claims. The MAI Act provides that weekly benefits and treatment and care benefits may continue beyond 52 weeks if the injury is still active and treatment is clinically necessary. SIRA reviews these cases on medical evidence, including reports from treating practitioners and independent medical assessments.
Third, evidence requirements are more flexible for remote claimants. SIRA accepts digital copies of medical records, scanned police reports, and correspondence with insurers, provided they are clear and not altered. Claimants are encouraged to keep a record of all communications, including emails and text messages, and to retain copies of all medical appointments and treatment plans.
Common Disputes and How They Are Resolved
The most frequent disputes in rural MAI Act transitional claims involve the assessment of whole person impairment and the duration of treatment and care benefits. For example, a claimant in Tamworth may have been diagnosed with a spinal nerve-root injury after a crash in 2015. The injury was initially assessed as a soft tissue injury under the old rules, but later found to have neurological signs not classified as radiculopathy. Under the Motor Accident Guidelines, such an injury may still qualify as a threshold injury under the old system, but not under the new definition.
SIRA resolves these disputes through a review process. The claimant may request a review of the WPI assessment, and SIRA may commission an independent medical assessment. If the dispute involves a claim for damages, SIRA may refer the matter to the CTP insurer for review, or the claimant may choose to pursue a common law claim through the NSW Supreme Court.
Another common issue is the timing of benefit claims. A claimant in Dubbo who was injured in 2014 and only began treatment in 2018 may face challenges in proving that the injury was caused by the accident. SIRA considers whether the delay in treatment was reasonable, and whether medical evidence supports a causal link between the accident and the injury. In such cases, a treating practitioner’s statement explaining the delay and confirming the injury’s origin can be critical.
Practical Steps for Claimants in Rural and Remote NSW
If you were involved in a motor accident in rural or remote NSW before 1 July 2017 and are still receiving treatment or seeking compensation, you should:
- Contact your CTP insurer as soon as possible to confirm the status of your claim under the MAI Act.
- Gather all medical records, including notes from general practitioners, physiotherapists, and any specialist assessments.
- Preserve any police reports, accident scene photos, and witness contact details.
- Keep a log of all communications with insurers, medical providers, and legal representatives.
- Seek advice from a legal or claims professional familiar with transitional CTP claims, particularly if you are seeking damages or have been denied benefits.
SIRA’s guidance confirms that time limits for making a claim still apply. For claims that began before 1 July 2017, the standard 3-year limitation period from the date of the accident still applies. However, SIRA may allow extensions in exceptional circumstances, particularly where the claimant was unaware of the injury’s full impact until later.
Next Steps
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.