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).
If your NSW CTP claim is disputed over medical assessments, retaining the right evidence is critical. Under the Motor Accident Injuries Act 2017, claimants must demonstrate that their injuries meet SIRA's medical guidelines. This article explains what evidence to preserve, how to avoid disputes with PICs in Ashfield, and when to seek legal advice.
Legal Framework for Medical Disputes
NSW CTP claims rely on the Motor Accident Injuries Act 2017 and SIRA's medical guidelines. When a claimant disputes a medical assessment, the Personal Injury Commission (PIC) evaluates whether the injury meets the 'threshold injury' definition. This requires evidence showing:
- A spinal nerve-root injury with neurological signs (excluding radiculopathy)
- Clinical signs matching the Motor Accident Guidelines
- A direct link between the accident and the injury
SIRA explicitly states that medical records must show 'a reasonable degree of medical certainty' about the injury's cause and severity. Without this, disputes over assessment validity are common.
Key Evidence to Retain
To support your claim during a medical dispute, keep these records:
- Medical reports: Include all assessments, imaging, and specialist opinions. Highlight how each document connects the injury to the accident.
- Accident details: Preserve police reports, witness statements, and photos of the scene. These help establish the incident's circumstances.
- Income records: Show lost wages or reduced earning capacity, as this affects weekly benefit calculations.
- Correspondence: Save all emails or letters with PICs, insurers, or medical professionals. These track communication timelines.
- Treatment records: Document all medical treatments, including physiotherapy sessions, medications, and follow-up appointments.
Preventing Evidence Disputes
PICs in Ashfield often challenge claims by questioning the reliability of medical evidence. To avoid this:
- Request written confirmation from your doctor that your injury meets SIRA's threshold criteria.
- 2. Keep records of all assessments
- even minor ones
- to show a continuous treatment history.
- Avoid altering medical records; any changes must be documented and explained.
- Submit evidence promptly - delays can lead to claims being dismissed as 'not reasonably foreseeable' under s 3.28 of the Motor Accident Injuries Act 2017.
When to Seek Legal Advice
Disputes over medical assessments often require legal intervention. Consider consulting a solicitor if:
- The PIC rejects your claim without providing specific reasons
- You receive a 'no liability' determination despite medical evidence
- You face a 'no claim' decision after 52 weeks (per s 4.4 of the Act)
Legal professionals can help challenge PIC decisions, request internal reviews, or escalate disputes to the NSW Civil and Administrative Tribunal (NCAT). Remember, a challenge does not guarantee a changed decision - the PIC must find your evidence 'more likely than not' to be accurate.
Next Steps
CTP claims involving medical disputes have strict time limits and procedural requirements. To ensure your evidence is properly evaluated, complete the quick, no obligation enquiry form. A legal professional can review your records and advise on the best course of action.