How the MAI Act 2017 Defines Returning to Daily Activities
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 Motor Accident Injuries Act 2017 (MAI Act) sets the legal framework for statutory benefits under NSW’s Compulsory Third Party (CTP) scheme. A key provision is the definition of 'returning to daily activities, ' which determines when a claimant is no longer eligible for weekly benefits or treatment and care payments. Under the MAI Act, this is assessed based on whether the injured person can perform ordinary daily tasks such as cooking, shopping, or managing personal hygiene without significant difficulty.
The Act does not explicitly define 'returning to daily activities, ' but SIRA’s Motor Accident Guidelines provide practical guidance. For example, claimants must demonstrate they can perform these tasks independently, without requiring assistance from others. This assessment is critical because weekly benefits under the CTP scheme typically stop after 52 weeks if the injury is classified as a 'threshold injury' (see MAI Act s 4.4).
SIRA Resources for Assessing Daily Activity Recovery
SIRA’s official resources clarify how insurers evaluate claims related to daily activity recovery. The Making a Motor Accident Claim page explains that claimants must provide evidence of their capacity to perform daily tasks, such as:
- Medical reports detailing functional capacity
- Activity logs tracking progress
- Statements from treating medical practitioners
SIRA also outlines that 'returning to daily activities' is not solely about resuming work. It includes the ability to manage household responsibilities, personal care, and social participation. For instance, a claimant who can no longer cook meals independently may be deemed unable to return to daily activities, even if they are not employed.
Evidence Required to Prove Capacity for Daily Tasks
To support a claim that the injured person has returned to daily activities, claimants must gather specific evidence. Key documents include:
- Medical records showing the ability to perform daily tasks without assistance
- Activity logs documenting progress over time
- Witness statements from family members or carers
- Occupational therapy reports assessing functional capacity
For example, a claimant who has recovered enough to prepare simple meals independently would need to provide a medical opinion confirming this ability. Insurers may also request a functional capacity assessment to verify this.
Time Limits and Dispute Resolution
The MAI Act imposes strict time limits for CTP claims. Weekly benefits generally stop after 52 weeks if the injury is a 'threshold injury' (see MAI Act s 3.28). However, this does not automatically mean the claimant has fully recovered. Instead, it indicates that the injury has reached a level where the claimant can return to daily activities.
Disputes may arise if an insurer disputes the claimant’s ability to return to daily activities. In such cases, claimants should:
- Request a detailed explanation of the insurer’s assessment
- Seek a second opinion from an independent medical practitioner
- Submit additional evidence to support their case
Each claim is evaluated based on the individual’s circumstances, including the nature of the injury and the evidence provided.
When to Seek Legal Advice
While the MAI Act and SIRA guidelines provide a framework, claimants may need legal assistance to navigate complex issues. For example, if an insurer disputes the claimant’s capacity to return to daily activities, a solicitor can help challenge the decision. Legal advice is also recommended if:
- The claimant is unsure whether their injury qualifies as a 'threshold injury'
- The insurer refuses to consider new evidence
- The claimant needs to dispute a decision to stop weekly benefits
Legal professionals can also help claimants understand their rights under the MAI Act and ensure they meet all procedural requirements.
Next Steps for Claimants
If you or a loved one has been injured in a motor accident and are seeking compensation, it is essential to understand how the MAI Act applies to your situation. The legal framework for 'returning to daily activities' can be complex, and time limits may affect your entitlements.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.