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 disputing a medical assessment in a NSW Compulsory Third Party (CTP) claim about returning to daily activities, understanding the legal process is critical. SIRA (State Insurance Regulatory Authority) oversees medical assessments under the Motor Accident Injuries Act 2017. This article explains how disputes are resolved, what evidence matters, and the steps to challenge a medical report in Balmain. Time limits and procedural rules apply, so it’s important to act promptly. General information cannot determine whether a claim is available in an individual case. Complete the quick, no obligation enquiry form to request contact about your circumstances.
How SIRA Handles Medical Assessment Disputes
SIRA evaluates medical assessments based on the Motor Accident Guidelines, which define what constitutes a threshold injury or long-term impairment. If you disagree with a medical report, you must provide evidence that the assessment is incorrect or incomplete. This includes:
- Independent medical opinions from registered medical practitioners
- Detailed records of daily activities, such as work, exercise, or household tasks
- Evidence of medical treatment and its impact on your ability to perform daily activities
SIRA may request a second medical opinion if the initial report is disputed. The authority’s role is to determine whether the claimant’s injuries align with the guidelines for benefits like weekly income payments or treatment and care benefits.
Evidence Required for Claims About Returning to Daily Activities
To support a claim that you can return to daily activities, you must provide:
- Medical records showing recovery progress and functional capacity
- Accident reports and witness statements confirming the incident’s impact
- Income records to demonstrate how injuries affect your ability to work
- Diary or log entries documenting daily activities and limitations
For example, if you claim you can return to work but the medical report says otherwise, evidence of job-related tasks completed without exacerbating injuries is essential. SIRA will assess whether the medical assessment accurately reflects your functional capacity.
Legal Steps to Resolve Medical Assessment Disputes
If a medical assessment dispute arises, follow these steps:
- Submit a written objection to SIRA within 28 days of receiving the report. This deadline is strict and applies to all CTP claims.
- Provide supporting evidence as outlined above. SIRA will review your submission and may request additional information.
- Request a second medical opinion if the dispute escalates. SIRA will cover the cost of an independent assessment.
- Appeal to the Personal Injury Commission if SIRA’s decision is unsatisfactory. This is a formal process with specific timelines.
It’s important to note that disputing a medical assessment does not guarantee a change in the decision. SIRA and the Personal Injury Commission will weigh all evidence and apply the Motor Accident Guidelines strictly.
When to Seek Legal Advice
Medical assessment disputes can be complex, especially when they involve long-term impairments or threshold injuries. If you’re unsure whether your evidence meets SIRA’s standards, or if you need help navigating the dispute process, seek advice from a solicitor specialising in NSW CTP claims. Legal professionals can help you prepare a strong case and ensure all procedural requirements are met.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.