What the PIC Expects in Partial Fault CTP Disputes
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).
In New South Wales, the Primary Insurance Company (PIC) handles claims under the Compulsory Third Party (CTP) scheme when more than one party contributed to a motor accident. If you're involved in a partial fault dispute, the PIC will assess fault based on evidence and legal guidelines. Understanding what the PIC expects can help you prepare a stronger claim.
Key Legal Framework for Partial Fault Claims
The Motor Accident Injuries Act 2017 and Motor Accident Guidelines govern CTP claims in NSW. Under these laws, the PIC must determine fault by considering:
- Evidence of fault: Police reports, witness statements, and expert opinions are critical. The PIC may request a medical report to assess injury severity.
- Shared liability: If both parties contributed to the crash, the PIC allocates fault proportionally. For example, if a driver ran a stop sign and another overspeeded, both may share responsibility.
- Threshold injuries: If your injuries fall below the threshold defined in the Motor Accident Guidelines (e.g., soft tissue injuries without neurological signs), the PIC may limit benefits after 52 weeks.
The PIC cannot award damages for injuries that don’t meet the threshold. This distinction is crucial in partial fault cases where fault allocation affects benefit eligibility.
Evidence the PIC Prioritises in Disputes
To resolve disputes, the PIC relies on specific evidence. Here’s what matters:
- Accident reports: Police or insurance company reports detailing how the crash occurred.
- Witness statements: Accounts from people who saw the incident, including traffic camera footage if available.
- Medical records: Documentation of injuries, including imaging and treatment notes, to prove the injury meets the threshold.
- Driver behavior: Evidence of speeding, distracted driving, or failure to stop.
For example, if a driver claims they were not at fault but there’s no witness to support this, the PIC may side with the other party. Conversely, a medical report showing a spinal nerve-root injury (even without radiculopathy) could qualify as a threshold injury.
Time Limits and Dispute Resolution
You have 6 months from the accident date to notify the PIC of your claim. If you fail to meet this deadline, you may lose your right to benefits. Disputes over fault must be resolved within this timeframe.
If the PIC denies your claim, you can:
- Request a review with the PIC within 60 days of the decision.
- Seek independent medical advice to challenge the PIC’s assessment of your injury.
- Appeal to the Personal Injury Commission (PIC) if the dispute remains unresolved.
Note: The PIC’s decision is not final unless you agree. Challenging a decision requires evidence that the fault allocation or injury assessment was incorrect.
When to Seek Legal Advice
The PIC’s decisions are legally binding, but they are not infallible. If you believe the PIC has misinterpreted fault or excluded a valid claim, you should:
- Consult a solicitor specialising in CTP disputes.
- Request a detailed explanation of the PIC’s reasoning.
- Gather additional evidence, such as a second medical opinion or traffic camera footage.
Legal advice is particularly important if the PIC limits your benefits after 52 weeks or disputes the severity of your injury.
Practical Steps for Partial Fault Claims
To strengthen your case, take these steps:
- Document the accident: Take photos of the scene, damaged vehicles, and any visible injuries.
- Keep medical records: Ensure all treatment is recorded, including consultations and test results.
- Notify the PIC promptly: Submit your claim within 6 months of the accident.
- Preserve witness contact details: Keep a list of anyone who saw the incident.
- Review the PIC’s decision: If you disagree, request a written explanation and consider legal options.
Summary of PIC Expectations
The PIC expects clear evidence of fault, adherence to the threshold injury rules, and timely claim submission. In partial fault disputes, the PIC will allocate responsibility based on proportionate fault. If your claim is denied, you can challenge the decision through internal reviews or legal action. Always act quickly and gather all relevant evidence to support your case.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.