Understanding the Permanent Impairment Threshold in NSW CTP 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).
In New South Wales, a permanent impairment threshold of 10% whole person impairment (WPI) determines whether a claimant may pursue damages for pain and suffering and loss of enjoyment of life in a motor accident compensation claim. This threshold applies under the Motor Accident Injuries Act 2017. If a claimant’s impairment is assessed at 10% or more, they may be eligible to claim damages, provided they meet other legal requirements. If the impairment is below 10%, the claimant may still receive treatment and care benefits and weekly income payments, but cannot claim damages unless they have a qualifying threshold injury under the Act.
How Disputes Over the Threshold Are Resolved in NSW
Disputes about whether a claimant meets the 10% threshold typically arise when an insurer or independent medical assessor (IMA) assesses the impairment and concludes it is below 10%. The claimant may disagree with that assessment. In such cases, the claimant has several formal dispute resolution options under the NSW Motor Accident Injuries scheme.
The primary mechanism for resolving disputes is through the Motor Accident Injuries (MAI) scheme administered by the State Insurance Regulatory Authority (SIRA). SIRA oversees the assessment process and provides a structured pathway for review. The claimant may request an internal review from the insurer, or apply directly to SIRA for a determination. SIRA may also initiate a review if it identifies a concern with the assessment.
Role of SIRA in Threshold Dispute Resolution
SIRA does not make final impairment assessments itself. However, it has authority to review and determine whether a claimant’s impairment meets the 10% threshold for damages eligibility. If a claimant disagrees with an IMA’s assessment, they may apply to SIRA for a review. SIRA will consider the medical evidence, including reports from treating medical practitioners, diagnostic imaging, and functional capacity assessments.
SIRA’s review process is independent and follows the Motor Accident Injuries Regulation 2017 and the Motor Accident Injuries Guidelines. These guidelines set out the criteria for assessing WPI, including the use of the Australian National Institute of Health and Medical Research (NHMRC) standards and the International Classification of Functioning, Disability and Health (ICF) framework. SIRA may also refer the claim to the Personal Injury Commission (PIC) if a medical dispute is involved, particularly where there is a disagreement about the nature or extent of the injury.
Practical Steps for Claimants in Bathurst
If you live in Bathurst and believe your impairment assessment is incorrect, the following steps are recommended:
- Seek a second opinion from a treating medical practitioner who has been involved in your care since the accident. This doctor can provide a written opinion supporting your WPI assessment.
- Gather all medical records, including imaging reports (X-rays, MRIs), treatment notes, and functional capacity assessments.
- Contact your insurer to request a formal internal review of the assessment. Insurers must provide a written response within 28 days.
- If the insurer upholds the original assessment, you may apply to SIRA for a review. You can do this online via the SIRA website or by submitting a paper application.
- If the dispute involves a disagreement about medical findings, you may request that the matter be referred to the Personal Injury Commission for a medical dispute resolution process.
Time Limits and Procedural Requirements
There are time limits that apply to dispute resolution. You must apply to SIRA for a review within 12 months of receiving the insurer’s decision on the internal review. Missing this deadline may prevent you from seeking a formal determination. The 12-month period starts from the date of the insurer’s written decision, not the date of the original assessment.
SIRA will assess the evidence based on the law and guidelines, not on personal belief. The process may take several months, depending on the complexity of the medical evidence and whether a PIC referral is required.
Hypothetical Example: A Claimant in Bathurst
A 42-year-old resident of Bathurst was involved in a motor vehicle accident in April 2025. Following treatment for neck and back injuries, an IMA assessed her WPI at 8%. She believes her ongoing pain and limited mobility justify a higher assessment. She obtained a medical report from her specialist confirming a 12% WPI based on MRI findings and functional testing. She submitted a request for an internal review, which was denied. She then applied to SIRA for a review, providing all medical evidence. SIRA referred the matter to the Personal Injury Commission for a medical dispute resolution. After a review, SIRA upheld the 12% assessment, allowing her to proceed with a damages claim.
When to Seek Independent Legal Advice
While SIRA provides a structured process, the legal and medical complexities involved in threshold disputes often require independent advice. A solicitor experienced in motor accident claims can help you understand your rights, prepare a strong evidence package, and represent you in any review or dispute process. This is particularly important in regional areas like Bathurst, where access to specialist medical assessors and legal expertise may be limited.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.