Transitional Claims Under the MAI Act
The Motor Accident Injuries Act 2017 (MAI Act) replaced NSW’s old CTP scheme, but claims that started before and after the 2017 reforms are treated differently. Transitional claims involve accidents occurring before 2017 but claims filed after the law changed. Insurers assess liability by applying the legal rules in effect at the time of the accident, not when the claim was filed. For example, an accident in 2016 (pre-MAI Act) would be evaluated under the old CTP scheme, while a 2020 accident would use the new MAI Act rules.
How Insurers Evaluate Liability
- Insurers determine liability by first identifying the accident date. Claims under the old CTP scheme (pre-2017) are governed by the
- Compulsory Third Party (CTP) Insurance Act 1998* and the
- Motor Accidents Claims Act 1998*. Under these rules, claimants could seek damages for injuries like whiplash or soft tissue injuries, regardless of fault. In contrast, the MAI Act (s 4.4) limits compensation for 'threshold injuries', injuries that don’t meet the whole person impairment threshold, after 52 weeks.
Insurers also assess whether the injury qualifies as a 'threshold injury' under the current guidelines. For example, a spinal nerve-root injury with neurological signs may still count as a soft-tissue injury, even if radiculopathy (nerve root irritation) isn’t present. This distinction affects whether a claimant is eligible for ongoing weekly payments or treatment benefits.
Key Evidence for Transitional Claims
Claimants must provide evidence to support their case. Medical records are critical to prove the nature and severity of the injury. Insurers will compare the injury to the Motor Accident Guidelines to determine if it meets the threshold for compensation. Accident reports, witness statements, and photographs of the scene can also help establish liability.
Income records are important if the claimant is seeking weekly payments for lost wages. Insurers may also review communication with the insurer, such as correspondence about the claim’s progress or medical treatment.
SIRA Resources for Transitional Claims
The State Insurance Regulatory Authority (SIRA) provides guidance on transitional claims. Their website explains how to claim under both the old and new schemes, including how to apply for treatment benefits, weekly payments, and lump sum damages. SIRA also outlines the process for disputing an insurer’s decision, such as requesting a review or mediation.
Practical Steps for Claimants
- Seek medical attention immediately after the accident to document injuries.
- Preserve accident details, including police reports, witness contact information, and photos of the scene.
- Notify the insurer in writing, clearly stating the accident date and your claim for compensation.
- Review SIRA’s guidelines to understand your rights under the applicable scheme.
- Request a review if the insurer denies or limits your claim, as transitional claims often require careful analysis of the injury’s classification.
When to Seek Legal Advice
Transitional claims can be complex, especially if the injury overlaps both pre- and post-2017 rules. For example, a claimant injured in 2016 but filing a claim in 2020 may need to prove that their injury meets the threshold for ongoing payments under the new MAI Act. Legal advice is recommended if the insurer disputes liability, limits benefits, or refuses to acknowledge the transitional nature of the claim.
Example of a Transitional Claim
Consider a claimant injured in a car accident in 2016 (pre-MAI Act) but filing a claim in 2020. Under the old CTP scheme, they could claim damages for soft-tissue injuries regardless of fault. However, under the MAI Act, their claim would be limited to threshold injuries, and benefits would stop after 52 weeks unless they meet the whole person impairment threshold. This example shows how the accident date, not the claim date, determines the applicable rules.
Next Steps
Time limits and procedural requirements vary depending on the accident date and injury type. To request contact about your circumstances, complete the quick, no obligation enquiry form.