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).
If you're involved in a motor accident where both parties share responsibility, understanding how to resolve your claim under NSW's Compulsory Third Party (CTP) scheme is critical. In regional NSW, dispute resolution processes differ from metropolitan areas, and the NSW government's State Insurance Regulatory Authority (SIRA) oversees these claims. This article explains how partial fault claims are handled, the options available to challenge insurer decisions, and the practical steps to take when resolving disputes in regional areas.
How SIRA Handles Partial Fault Claims
Under the Motor Accident Injuries Act 2017, CTP claims involving multiple parties must account for shared fault. SIRA calculates compensation based on the 'percentage of fault' attributed to each party. For example, if a driver and cyclist both contributed to an accident, SIRA will apportion liability and reduce the injured party's entitlements accordingly. This process is outlined in SIRA's Making a Motor Accident Claim guidelines, which emphasize that fault assessments depend on evidence like police reports, witness statements, and medical records.
In regional NSW, SIRA's dispute resolution options are limited compared to major cities. While metropolitan areas have access to mediation services and the Personal Injury Commission (PIC), regional claimants must rely on SIRA's internal review process. This involves submitting a written objection to the insurer's decision, supported by evidence that challenges the fault calculation.
Practical Steps for Partial Fault Claims
To resolve a partial fault claim, injured road users should:
- Gather all evidence, including medical records, accident reports, and witness details.
- Document the extent of injuries and how they impact daily life.
- Submit a formal written objection to the insurer's fault assessment.
- Seek independent medical opinions if the injury's severity is disputed.
SIRA requires claims to be submitted within 52 weeks of the accident, unless an extension is granted. If the injury is classified as a 'threshold injury' (e.g., soft tissue damage), benefits may be limited after this period. However, this does not apply to claims involving permanent impairment or significant long-term consequences.
Dispute Resolution in Regional NSW
In areas without major cities, claimants may face delays in accessing dispute resolution services. SIRA's internal review process is the primary avenue, but it can take up to 12 weeks to resolve. If the insurer's decision remains unchanged, claimants may need to escalate the matter to the NSW Civil and Administrative Tribunal (NCAT) for a formal review.
A key consideration is the 'medical dispute pathway' under the PIC. If the injury's severity or treatment is contested, claimants can request an independent medical assessment. This process is outlined in SIRA's What You Can Claim guidelines and is available regardless of location.
Example: Challenging a Shared Fault Calculation
Consider a scenario where a cyclist and a car driver collide at a red light. SIRA determines the cyclist was 40% at fault and the driver 60%, reducing the cyclist's compensation by 40%. If the cyclist believes the fault allocation is unfair, they can:
- Submit a written objection with evidence (e.g., traffic camera footage, witness statements).
- Request an independent medical assessment to challenge the injury's severity.
- Escalate to NCAT if the insurer refuses to revise the calculation.
When to Seek Legal Advice
Disputes over shared fault can be complex, especially when injuries involve long-term consequences. In regional NSW, claimants may need to seek legal assistance to:
- Navigate SIRA's internal review process.
- Challenge fault assessments based on new evidence.
- Pursue compensation for permanent impairment or ongoing care needs.
While the process can be time-consuming, claimants have the right to request a review of fault calculations and injury assessments.
Next Steps for Regional Claimants
If you're in regional NSW and facing difficulties resolving a partial fault CTP claim, the first step is to submit a written objection to the insurer. Gather all relevant evidence and consider seeking independent medical opinions. If the dispute persists, you may need to escalate the matter to NCAT or seek legal advice to explore further options.
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