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 in Bega NSW and disagree with a medical assessment for a CTP claim, you have options to challenge the decision. This article explains how to resolve disputes under NSW law, including using SIRA resources and navigating the Personal Injury Commission (PIC) process.
How to Challenge a Medical Assessment in CTP Claims
Under the Motor Accident Injuries Act 2017, claimants can dispute PIC assessments by following a structured process. First, you must request an internal review of the medical report from the insurer. This review must be completed within 28 days of receiving the report, as per SIRA guidelines. If the review outcome is unsatisfactory, you can escalate the matter to the Personal Injury Commission (PIC) for further assessment.
The PIC has specific rules for medical disputes. For example, if you believe the assessment is incorrect or incomplete, you can submit additional evidence such as independent medical opinions, diagnostic test results, or records of treatment. SIRA’s Motor Accident Guidelines provide detailed criteria for evaluating injuries, which can help you challenge a report that fails to meet these standards.
Key Steps for Claimants in Bega
- Request an internal review: Contact the insurer’s claims manager to ask for a review of the medical report. This must be done within 28 days of receiving the report.
- Submit additional evidence: If the review is unsatisfactory, provide new medical records or expert opinions to support your case.
- Escalate to the PIC: If the insurer refuses to revise the assessment, you can apply to the PIC for a review. This process is free and does not require legal representation.
- Use SIRA resources: SIRA’s guidelines on what you can claim and how to challenge assessments are critical. For example, if the PIC’s assessment does not account for spinal nerve-root injuries (as defined in the Motor Accident Guidelines), you can argue the report is incomplete.
Time Limits and When to Seek Advice
The 28-day internal review period is strict. Missing this deadline may prevent you from challenging the assessment. If the insurer refuses to review the report or disputes the medical evidence, you should seek legal advice promptly. Delays can reduce your chances of a successful challenge, especially if the PIC’s decision is final.
Example: Disputing a Threshold Injury Assessment
Suppose a claimant in Bega receives a report stating their injury is a ‘threshold injury’ under the Motor Accident Injuries Act 2017. They may challenge this by showing the injury meets the spinal nerve-root criteria in the Motor Accident Guidelines. For instance, if the report fails to note neurological signs beyond radiculopathy, the claimant can argue the assessment is incorrect. This highlights how SIRA’s guidelines can be used to dispute PIC decisions.
Next Steps
Medical assessment disputes require careful timing and evidence. If you’re in Bega and need help resolving a disagreement with a PIC report, contact a legal professional. General information cannot determine whether a claim is available in your case. Time limits and procedural requirements may apply. To request contact about your circumstances, complete the quick, no obligation enquiry form.