How NSW CTP Insurers Assess Partial Fault Claims
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).
NSW insurers assess partial fault claims by dividing liability between parties involved in a motor accident. Under the Motor Accident Injuries Act 2017 (MAIA), claims where more than one driver contributed to the crash are handled by determining each party’s share of responsibility. This process involves evaluating evidence such as police reports, witness statements, and medical records to establish fault percentages. Insurers use these assessments to calculate compensation entitlements under the Compulsory Third Party (CTP) scheme.
Key Factors in Partial Fault Assessments
NSW insurers consider several factors when determining liability in shared fault scenarios:
- Evidence of fault: Police reports, traffic camera footage, and witness accounts help establish who contributed to the crash.
- Contributory negligence: If a claimant was also at fault, insurers reduce their compensation based on the proportion of their own responsibility.
- SIRA guidelines: The State Insurance Regulatory Authority (SIRA) provides standards for assessing injuries and determining benefit entitlements. For example, SIRA’s Motor Accident Guidelines outline how to evaluate soft-tissue injuries and threshold injuries.
- Vehicle and road conditions: Factors like speed, traffic signals, and road hazards may influence liability decisions.
Determining Liability Percentages
Insurers typically assign a percentage of fault to each party. For instance, if a driver ran a red light (60% fault) and another driver oversped (40% fault), the claimant’s compensation would be adjusted accordingly. Under MAIA s 4.4, if a claimant’s only injuries are threshold injuries (e.g., soft-tissue damage), benefits are limited to 52 weeks. This applies even if liability is shared, as the 52-week cap is based on injury severity, not fault percentage.
Role of SIRA Guidelines in Shaping Decisions
SIRA’s guidelines are critical in standardizing insurer assessments. They define what constitutes a threshold injury, outline how to calculate weekly income payments, and specify when benefits must stop. For example, if a claimant’s injuries exceed threshold criteria, insurers may award long-term compensation despite shared fault. SIRA also provides tools like the Motor Accident Claims Calculator to help assess entitlements.
Practical Steps for Claimants
To support a partial fault claim, gather:
- Police reports detailing the accident and fault
- Witness statements
- Medical records confirming injuries
- Evidence of income loss (e.g., payslips)
- Communication with insurers about claim progress
If an insurer denies or limits a claim, claimants may need to request a review or seek independent assessment. The 52-week limit for threshold injuries applies regardless of fault, so claimants should monitor their entitlements closely.
When to Seek Legal Advice
Complex cases involving multiple parties, disputed fault, or injuries exceeding threshold criteria may require legal assistance. An experienced solicitor can help challenge insurer decisions, negotiate better outcomes, or pursue a common law damages claim if CTP benefits are insufficient.
Next Steps
CTP entitlements depend on the accident date, fault distribution, and injury severity. To understand how insurers assess your specific situation, complete the quick, no obligation enquiry form. Every claim depends on its own facts.