How SIRA Interprets the Motor Accident Injuries Act 2017
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 (MAIA) governs statutory benefits for CTP claims in NSW. SIRA (State Insurance Regulatory Authority) provides authoritative guidance on applying the Act, particularly in Greater Sydney. SIRA’s interpretations clarify how injuries are assessed, what benefits are available, and how claims are processed under the MAIA.
Key aspects of SIRA’s approach include:
- Threshold injury definitions: SIRA uses the Motor Accident Guidelines to determine if an injury meets the 'threshold injury' standard, which qualifies for statutory benefits.
- Weekly income payments: SIRA calculates weekly payments based on the claimant’s pre-accident income, applying the 52-week limit for 'only injuries' cases.
- Dispute resolution: SIRA outlines processes for challenging benefit decisions, including the right to request a review or escalate to the NSW Civil and Administrative Tribunal (NCAT).
Practical Steps for CTP Claimants
To navigate SIRA’s rules effectively, claimants should:
- Document all injuries: Medical records must clearly show the nature and severity of injuries, including any spinal nerve-root injuries.
- Preserve accident details: Police reports, witness statements, and photographs are critical evidence.
- Notify your insurer: Under the MAIA, claimants must inform their insurer within 52 weeks of the accident.
- Seek medical attention: Delayed treatment may affect eligibility for benefits, as SIRA requires a 'reasonable opportunity' to seek care.
Time Limits and Dispute Options
The MAIA imposes strict deadlines:
- 52-week limit: Weekly benefits and treatment benefits are generally limited after 52 weeks unless the injury is not a 'threshold injury' (s 4.4 MAIA).
- Dispute resolution: If a claimant disagrees with a benefit decision, they can request a review from SIRA or escalate to NCAT within 28 days of the decision.
- Statutory deadlines: Failure to notify the insurer within 52 weeks may result in loss of weekly income payments.
When to Seek Legal Advice
SIRA’s guidance is technical, and claimants may need legal assistance to:
- Challenge a benefit decision (e.g., if an injury is misclassified as a 'threshold injury').
- Navigate complex claims involving multiple injuries or long-term care needs.
- Understand their rights under the MAIA, especially if the accident occurred before 1 December 2017 (when the MAIA replaced the former scheme).
Example: SIRA’s Application of the MAIA
Consider a claimant who suffered a soft-tissue injury after a car accident in Sydney. SIRA would assess whether the injury meets the threshold injury definition under the Motor Accident Guidelines. If the injury involves a spinal nerve-root injury with neurological signs (not radiculopathy), it may still qualify. If the injury is classified as a 'threshold injury', weekly benefits would generally stop after 52 weeks unless the claimant has additional injuries.
Next Steps
CTP entitlements depend on the accident date, injury type, and claim history. To request contact about your circumstances, complete the quick, no obligation enquiry form.