Understanding the Permanent Impairment Threshold
Under New South Wales law, a claimant must prove their injury meets the 10% whole person impairment threshold to qualify for permanent impairment compensation under the Motor Accident Injuries Act 2017. This threshold means the injury must significantly reduce the person's physical or mental capacity to function in daily life. Insurers use the SIRA Guidelines for Motor Accident Claims to assess whether an injury meets this standard, focusing on clinical evidence like medical reports and specialist opinions.
How Insurers Evaluate Claims
Insurers in Western Sydney typically apply the SIRA guidelines by:
- Reviewing medical records from doctors, physiotherapists, and specialists
- Considering the nature and severity of the injury
- Assessing how the injury affects the claimant's ability to work, care for dependents, or perform daily tasks
- Comparing the injury to the 10% threshold described in the SIRA guidelines
For example, a claimant with a 12% impairment from a spinal injury might be eligible, while a 9% impairment from a soft tissue injury would not meet the threshold. Insurers may request additional evidence if they doubt the assessment.
Steps to Challenge a Rejection
If an insurer rejects a permanent impairment claim, the claimant can:
- Request a detailed explanation of why the injury does not meet the threshold
- Provide additional medical evidence, such as a second opinion from a specialist
- Submit a formal dispute to the insurer within 28 days of the decision
- Seek independent review by a SIRA-appointed medical assessor if the claim is denied
Claimants should ensure all evidence clearly links the injury to the 10% threshold and demonstrates how it impacts daily life.
Time Limits and Disputes
Claimants must notify their insurer of a permanent impairment claim within 28 days of the accident. If the insurer disputes the claim, they must respond within 28 days of receiving the claim. Delays beyond these timeframes may weaken the claimant's position. Claimants should seek legal advice if the insurer refuses to engage with the claim or if the claim is denied without explanation.
When to Seek Advice
Insurers in Western Sydney may interpret the 10% threshold narrowly. Claimants should consult a legal professional if:
- The insurer requests additional evidence without a clear reason
- The claim is denied without a detailed explanation
- The claimant believes the injury meets the threshold but the insurer disagrees
Legal experts can help challenge unfair decisions and ensure claimants receive the compensation they are entitled to under NSW law.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.