Permanent Impairment Threshold in NSW CTP Claims
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).
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).
Under New South Wales law, a claimant must demonstrate a permanent impairment of at least 10% whole person impairment (WPI) to qualify for additional compensation beyond statutory benefits. This threshold determines whether a claimant is eligible for damages for loss of earnings, future medical treatment, or other long-term consequences. The Motor Accident Injuries Act 2017 (MAIA) and SIRA’s assessment guidelines govern this calculation.
How Insurers Assess Permanent Impairment
Insurers use the Australian Guide to the Assessment of Permanent Impairment (AGA) to evaluate injuries. A medical practitioner must prepare a report detailing:
- The nature and extent of the injury
- The percentage of whole person impairment
- Whether the impairment is permanent
For example, a fractured wrist that results in 12% WPI would meet the threshold. However, a minor sprain with 8% WPI would not. SIRA’s regional office in Albury applies these standards consistently, though assessments may vary depending on the complexity of the injury.
Practical Examples from Albury NSW
A 2023 case in Albury involved a cyclist who suffered a spinal nerve-root injury. The medical report concluded a 14% WPI due to chronic pain and reduced mobility. The claimant was awarded damages for lost income and future medical costs. In contrast, a pedestrian with a 7% WPI from a minor leg injury received only statutory benefits, as the threshold was not met.
Time Limits and When to Seek Advice
Claims must be made within 52 weeks of the accident for statutory benefits. For damages claims, the 52-week period applies only if the injury is a 'threshold injury' (i.e., it meets the 10% WPI threshold). If the injury does not meet the threshold, the 52-week limit does not apply. However, delays in seeking medical attention or failing to document injuries can weaken a claim.
Key Considerations for Albury Claimants
- Medical evidence: A detailed report from a registered medical practitioner is essential.
- Accident documentation: Police reports, witness statements, and photographs can support the claim.
- SIRA’s role: SIRA assesses claims under the MAIA. Claimants can request a review of their impairment assessment.
- Dispute resolution: If an insurer rejects a claim, claimants may apply to the NSW Civil and Administrative Tribunal (NCAT) for a review.
Next Steps
The availability of compensation depends on the specific facts of each case. To discuss your circumstances, complete the quick, no obligation enquiry form. A legal professional can help assess whether your injury meets the 10% WPI threshold and guide you through the claims process.