Where a person's only injuries resulting from the accident are threshold injuries, weekly benefits and treatment and care generally cease after 52 weeks (ss 3.11 and 3.28).
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).
The 2017 reforms to NSW Compulsory Third Party (CTP) motor accident compensation introduced significant changes to how medical assessments are handled in claims. These reforms, under the Motor Accident Injuries Act 2017, altered the role of Independent Medical Examiners (IMEs) and the process for disputing medical reports. This article explains the key changes, how they affect claimants in Bathurst, and practical steps to challenge medical assessments.
Key Changes to Medical Assessment Disputes
The 2017 reforms shifted responsibility for medical assessments from the Personal Injury Commission (PIC) to Independent Medical Examiners. Under the new rules, claimants must now seek an independent medical opinion to dispute a PIC assessment. This change was designed to streamline the process and reduce delays.
Previously, the PIC would assess the injury and determine the level of impairment. Now, claimants must request an IME to evaluate the injury and provide an alternative opinion. If the IME’s findings differ from the PIC’s report, the claimant can submit the IME’s assessment to the PIC for reconsideration.
How the Reforms Affect Bathurst Claimants
In Bathurst, claimants must now follow the revised process to challenge medical assessments. For example, if a PIC report concludes that an injury is a 'threshold injury' (a minor soft-tissue injury), the claimant must obtain an IME opinion to dispute this. The IME must assess whether the injury meets the threshold injury criteria under the Motor Accident Guidelines.
A key change is that the PIC no longer conducts medical assessments. Instead, claimants must independently seek an IME opinion. This means claimants must now take proactive steps to secure an independent medical opinion, which was not previously required.
Practical Steps for Challenging Medical Assessments
To dispute a medical assessment under the revised rules, claimants should:
- Obtain an Independent Medical Examiner’s report within 52 weeks of the accident.
- Ensure the IME’s assessment addresses all aspects of the PIC’s report, including the injury’s severity and long-term impact.
- Submit the IME’s findings to the PIC for a review of the claim.
Medical records, accident reports, and evidence of ongoing treatment are critical. Claimants must also be aware that the PIC may require additional evidence to support a challenge.
Time Limits and When to Seek Advice
The 52-week time limit for seeking medical benefits applies to all claims. If a claimant fails to obtain an IME opinion within this period, they may lose the right to challenge the PIC’s assessment. This deadline is strict and cannot be extended unless there is a valid reason for delay.
Claimants should seek legal advice promptly if they believe the PIC’s assessment is incorrect. A solicitor can help navigate the process of securing an IME opinion and submitting it to the PIC.
Example: Disputing a Threshold Injury Assessment
Consider a claimant in Bathurst who was involved in a car accident and received a PIC report stating their injury was a 'threshold injury.' The claimant may dispute this by obtaining an IME opinion. If the IME concludes the injury is more severe, the PIC may reconsider the claim. However, the claimant must act within 52 weeks and provide sufficient evidence to support the challenge.
Next Steps
CTP claims involving medical assessments require careful attention to the revised rules. The 2017 reforms have changed how claimants challenge medical reports, and failure to follow the correct process may result in lost benefits. For tailored advice on your specific circumstances, complete the quick, no obligation enquiry form.