Understanding the PIC’s Role in Disputes Over Pedestrian Crossing Injuries
If you were struck by a vehicle while crossing a marked pedestrian crossing in Greater Sydney, you may face a dispute with the Compulsory Third Party (CTP) insurer about your claim. The Personal Injury Claimant (PIC) is expected to provide clear, factual evidence and cooperate with the claims process. Disputes often arise over the extent of injury, causation, or the need for treatment. The PIC must demonstrate that the injury occurred during the motor accident and that it is not pre-existing or unrelated. SIRA’s guidance confirms that claimants must actively engage in resolving disputes by submitting all relevant documentation and responding to requests within reasonable timeframes.
What the CTP Scheme Requires for Pedestrian Injury Claims
Under the Motor Accident Injuries Act 2017 (MAIA), all motor accident claims in NSW are governed by a single statutory framework. This includes claims by pedestrians who were struck at a marked crossing. The CTP insurer must assess whether the injury qualifies for treatment and care benefits, weekly income payments, or damages. For claims involving a pedestrian, the insurer will examine whether the accident occurred in a motor vehicle context, whether the pedestrian was lawfully crossing, and whether the driver had a duty of care. The insurer may dispute liability or the nature of the injury, particularly if the injury is classified as a threshold injury under the Motor Accident Guidelines.
Evidence That Matters in Disputes
When a dispute arises, the PIC must provide evidence that supports the claim. Critical items include:
- A medical record from a treating practitioner detailing the injury, diagnosis, and treatment plan.
- Photographs of the accident scene, including the crossing, vehicle position, and any visible damage.
- A written statement from a witness who observed the accident.
- A police report, if one was filed at the time of the incident.
- Evidence of income loss, such as a letter from an employer or payslips.
SIRA emphasises that medical evidence must be contemporaneous and not retrospective. A claimant who delays reporting symptoms or seeking treatment may face challenges in proving causation. The PIC should not wait to gather all evidence before initiating a claim. Early submission of documentation helps prevent delays in the dispute resolution process.
How Disputes Are Managed and What the PIC Should Expect
If the insurer disputes the claim, the PIC may be invited to participate in a formal review process. The Personal Injury Commission (PIC) does not conduct disputes directly, but it oversees the review pathway for medical disputes and benefit entitlements. The PIC may request a medical assessment to determine whether the injury meets the threshold for damages. This process usually takes 12 to 16 weeks, depending on the complexity and the need for specialist input.
The PIC should expect that:
- The insurer will issue a formal decision notice outlining the grounds for dispute.
- The PIC has 28 days to request an internal review of the decision.
- If the internal review does not resolve the dispute, the PIC may apply to the Personal Injury Commission for a review of the medical assessment or benefit determination.
The PIC must respond to all correspondence within the timeframe specified. Failure to do so may result in the claim being closed or the dispute being dismissed. The PIC should not assume that a dispute will be resolved without active participation.
Practical Steps to Take When a Dispute Arises
If your claim is disputed, take the following steps immediately:
- Contact your medical practitioner to obtain a detailed report confirming the injury and its link to the accident.
- Gather all documentation related to the accident, including photos, witness statements, and any correspondence with the insurer.
- Submit a written request for an internal review within 28 days of receiving the insurer’s decision.
- If the internal review is unsuccessful, apply to the Personal Injury Commission for a review of the medical assessment or benefit denial.
The Commission will assess the evidence based on the Motor Accident Guidelines and the MAIA. The PIC should not expect automatic approval or a different outcome simply because a dispute was raised.
A Realistic Example: A Claimant’s Experience
A 38-year-old pedestrian in Sydney’s Inner West was struck by a car while crossing a marked crossing at a traffic light. The driver admitted fault, but the insurer disputed the claim on the grounds that the injury was not severe enough to qualify for damages. The claimant had sustained soft tissue injuries to the neck and back, with MRI results showing a minor disc bulge. The insurer argued that the injury did not meet the threshold for damages under the Motor Accident Guidelines.
The claimant responded by submitting a full medical report, including a specialist assessment confirming neurological signs consistent with a spinal nerve-root injury. The claimant also provided a witness statement and photos of the crossing. After an internal review, the insurer revised its position and agreed to pay treatment and care benefits. The claimant later obtained a medical assessment through the Commission, which confirmed the injury met the threshold for damages. The example illustrates that a PIC who provides thorough, timely evidence has a stronger position in a dispute.
When to Seek Independent Advice
Every claim depends on its own facts. The available options may depend on the facts, evidence and applicable law. The CTP scheme has strict time limits and procedural requirements. For example, a claim for damages must be made within three years of the accident, and a request for an internal review must be made within 28 days of receiving a decision.
If you are facing a dispute over a pedestrian crossing injury, it is advisable to seek independent legal advice before making any formal submissions. A solicitor can help you understand your rights under the MAIA, assess the strength of your evidence, and ensure that all procedural steps are followed correctly.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.