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 involved in a Compulsory Third Party (CTP) motor accident claim in Albury, understanding how to resolve disputes under the Motor Accident Injuries Act 2017 is critical. This article explains the formal processes available to claimants, including SIRA's internal review procedures, mediation options, and when to escalate disputes to formal complaints. It also outlines time limits and practical steps to take if your claim is contested.
How SIRA Handles CTP Disputes in Regional NSW
SIRA (State Insurance Regulatory Authority) manages all CTP claims under the Motor Accident Injuries Act 2017. If you disagree with a decision, the first step is to request an internal review. SIRA provides a written explanation of its decisions and allows claimants to submit additional evidence or clarification. For example, if a claimant believes their injury meets the threshold for weekly payments but SIRA declined the claim, they can ask for a review by writing to SIRA within 28 days of receiving the decision.
Dispute Resolution Options
- Internal Review: SIRA must consider all written submissions before making a final decision. This process is free and does not require legal representation. Claimants should include medical records, accident reports, and any correspondence with SIRA to support their case.
- Mediation: If the dispute involves a disagreement over the type or amount of benefits, claimants can request mediation through SIRA. Mediators help both parties reach a voluntary agreement without formal legal action.
- Formal Complaint: If SIRA's decision is unsatisfactory, claimants can escalate the matter to the NSW Civil and Administrative Tribunal (NCAT). This is a formal process where a tribunal member reviews the claim and may order SIRA to reconsider its decision. Note that NCAT does not provide legal advice or representation.
When to Escalate Disputes
Escalating a dispute to NCAT is only appropriate if SIRA's decision is legally incorrect or if there is a procedural error. For example, if SIRA failed to consider relevant medical evidence or misinterpreted the Motor Accident Guidelines, a claimant may have grounds for a formal complaint. However, challenges do not guarantee a change in outcome, and claimants must demonstrate that SIRA's decision was based on a misunderstanding of the law.
Practical Steps for Claimants
- Gather Evidence: Medical records, accident reports, and witness statements are essential. For instance, if a claimant believes their injury meets the 'threshold injury' definition under the Act, they must provide clinical evidence to support this.
- Time Limits: Most disputes must be resolved within 28 days of receiving a decision. If a claimant misses this deadline, they may lose the right to challenge SIRA's decision.
- Seek Clarification: If unsure about a decision, claimants should contact SIRA directly to request a written explanation of the reasoning behind the outcome.
Example Scenario
Consider a claimant who suffered a soft-tissue injury in a car accident. SIRA declined the claim, arguing the injury did not meet the threshold. The claimant could request an internal review, providing MRI scans and a doctor's report confirming neurological signs. If SIRA still rejects the claim, the claimant could escalate to NCAT, arguing that the injury meets the spinal nerve-root qualification outlined in the Motor Accident Guidelines.
Next Steps
CTP disputes can be complex, especially in regional areas like Albury. While SIRA provides free internal review processes, claimants should seek legal advice if they face repeated rejections or procedural delays. Always act within time limits and ensure all evidence is submitted promptly. For personalized guidance, complete the quick, no obligation enquiry form to request contact about your circumstances.