What the PIC expects in pedestrian crossing injury disputes
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).
If you were injured as a pedestrian at a marked crossing in New South Wales, the Prescribed Injury Claimant (PIC) must assess whether your injury meets the criteria for compensation under the Motor Accident Injuries Act 2017. This article explains what evidence the PIC typically requires, how insurers evaluate disputes, and the legal boundaries governing their authority.
Key NSW CTP rules for pedestrian injuries
Under the Motor Accident Injuries Act 2017, the PIC must determine if your injury qualifies as a 'threshold injury' or a more serious impairment. For pedestrian crossing injuries, the PIC will consider:
- Medical evidence confirming the injury (e.g., imaging, specialist reports)
- Accident details such as traffic camera footage, witness statements, and road condition reports
- Compliance with SIRA guidelines on injury severity and treatment
The PIC must also verify that the injury occurred at a marked crossing, as this affects eligibility. For example, injuries at unmarked crossings may not qualify for statutory benefits, even if the pedestrian was at fault.
Evidence critical to satisfying PIC requirements
To support your claim, you must provide:
- Medical records showing the injury's impact (e.g., pain, mobility restrictions, or psychological effects)
- Accident reports from the NSW Police or traffic authorities
- Witness accounts confirming the incident and your actions
- Photographs of the crossing, vehicle damage, and any hazards
The PIC may dispute claims where evidence is incomplete or inconsistent. For instance, if medical records fail to link the injury to the accident, the PIC may reject the claim.
How insurers evaluate disputes
NSW CTP insurers assess disputes by comparing your injury to the Motor Accident Guidelines. Key factors include:
- Threshold injury criteria: Does your injury meet the spinal nerve-root or radiculopathy thresholds? (See Motor Accident Guidelines 2023, section 3.28)
- Impairment level: For injuries above threshold, the PIC must assess whole-person impairment using the Standardised Assessment of Impairment (SAI) tool
- Fault and contributory negligence: The PIC must determine if your actions contributed to the injury
Insurers may also challenge claims where the injury is deemed 'non-CTP related' (e.g., pre-existing conditions). In such cases, the PIC must provide evidence that the injury was caused by the motor vehicle accident.
Time limits and dispute resolution
Claims must be submitted within 52 weeks of the accident, unless the injury is not a threshold injury. After this period, statutory benefits like weekly payments typically stop, though you may still pursue a common law damages claim.
If the PIC disputes your claim, you can:
- Request an internal review with the Personal Injury Commission (PIC) within 28 days of the decision
- Seek independent medical evidence to challenge the PIC's assessment
- Appeal to the NSW Civil and Administrative Tribunal (NCAT) if the review is unsatisfactory
Note: A challenge does not guarantee a changed decision. The PIC must provide a 'reasonable and justifiable' basis for its assessment under section 4.4 of the Motor Accident Injuries Act 2017.
Practical example: Disputing a soft-tissue injury
Consider a scenario where a pedestrian is hit at a marked crossing with minor bruising. The PIC may dispute the claim, arguing the injury is below threshold. To counter this, you must:
- Provide medical evidence showing the injury caused ongoing pain or mobility issues
- Demonstrate that the injury meets the spinal nerve-root criteria in the Motor Accident Guidelines
- Show that the injury was directly caused by the motor vehicle accident
If the PIC rejects the claim, you may need to seek independent medical evidence to prove the injury's severity.
When to seek legal advice
Contact a solicitor if:
- The PIC denies your claim without a clear explanation
- You receive a 'no claim' decision after 52 weeks
- You need to challenge the PIC's assessment of your injury
Legal professionals can help you navigate the dispute process, request internal reviews, and prepare evidence for NCAT.
Next steps
CTP claims depend on the accident date, injury type, and evidence provided. To request contact about your circumstances, complete the quick, no obligation enquiry form.