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).
Pedestrian crossing injuries under NSW Compulsory Third Party (CTP) claims have changed significantly since the 2017 reforms. These changes affect how claims are processed, what benefits are available, and how injuries are assessed. This article explains the key updates relevant to Central Coast claimants and how to navigate the revised CTP scheme.
What Changed in the 2017 Reforms?
The 2017 reforms restructured NSW CTP claims to prioritize statutory benefits over common law damages. For pedestrian crossing injuries, this means:
- Statutory benefits now replace common law claims for injuries meeting the 'threshold injury' definition. This includes weekly income payments, treatment benefits, and compensation for loss of earnings.
- Threshold injuries are defined more strictly. Under the Motor Accident Injuries Act 2017, injuries must meet specific clinical criteria, such as spinal nerve-root damage producing neurological signs. Minor injuries like whiplash no longer qualify unless they meet these thresholds.
- 52-week limit for benefits. If a pedestrian’s only injuries are threshold injuries, weekly benefits and treatment payments generally stop after 52 weeks. This applies even if the injury is not severe.
These changes mean claimants must prove their injuries meet the new statutory criteria, not just demonstrate a common law injury.
How Central Coast Claimants Need to Adjust
Claimants on the Central Coast must now:
- Seek immediate medical attention to document injuries. Medical records must show injuries meet the threshold definition, such as spinal nerve-root damage or radiculopathy with specified clinical signs.
- Notify the at-fault driver’s insurer within 52 weeks of the accident. Delays may reduce benefits or result in claims being denied.
- Understand the 52-week benefit cap. If injuries are limited to threshold injuries, benefits stop after 52 weeks. This applies even if the injury is not severe.
- Review claims for disputes. If the insurer disputes the injury’s severity, claimants may need to provide additional medical evidence or seek independent assessment.
SIRA’s Guidance on Revised Rules
SIRA (State Insurance Regulatory Authority) clarifies that the 2017 reforms:
- Prioritize statutory benefits over common law claims. Claimants must apply for benefits under the Motor Accident Injuries Act 2017, not pursue a damages claim.
- Require strict adherence to injury thresholds. Injuries must meet specific clinical criteria, such as neurological signs or radiculopathy, to qualify for benefits.
- Limit benefits for non-severe injuries. Even if a pedestrian suffers a minor injury like a bruise, it will not qualify for statutory benefits unless it meets the threshold definition.
SIRA also emphasizes that claimants must submit claims within 52 weeks of the accident to avoid losing benefits. This applies to all Central Coast claimants, regardless of the injury’s severity.
Practical Steps for Claimants
To support a pedestrian crossing injury claim, gather:
- Medical records showing injuries meet the threshold definition.
- Accident reports from the Central Coast Council or police.
- Witness statements from drivers, pedestrians, or bystanders.
- Photographs of the crossing area, including traffic signs and road conditions.
- Income records to support claims for loss of earnings.
If the insurer disputes the claim, claimants should:
- Request a review of the medical evidence.
- Seek independent medical assessment if required.
- Contact a legal professional if benefits are denied.
When to Seek Advice
Claimants should consult a legal professional if:
- The injury is not classified as a threshold injury.
- Benefits are denied or disputed.
- The accident occurred more than 52 weeks ago.
- The claimant is unsure whether they qualify for statutory benefits.
Legal advice can help claimants understand their options under the revised CTP scheme and ensure they meet all requirements for benefits.
Next Steps
The 2017 reforms have significantly changed how pedestrian crossing injuries are assessed under NSW CTP claims. Claimants on the Central Coast must now meet stricter criteria for benefits and act quickly to avoid losing entitlements. Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.