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).
Under New South Wales law, a claimant must demonstrate a 10% whole person impairment to qualify for compensation under the Motor Accident Injuries Act 2017. This threshold determines whether a claimant is eligible for benefits like weekly payments, treatment and care benefits, or damages. The Personal Injury Commission (PIC) assesses whether an injury meets this standard, and disputes often arise when claimants believe their impairment is greater than 10%.
How PICs Assess Permanent Impairment
PICs use the Motor Accident Guidelines and SIRA's clinical assessment tools to evaluate injuries. Key factors include:
- Medical evidence from a specialist, such as a neurologist or orthopaedic surgeon.
- Clinical signs like neurological deficits, chronic pain, or functional limitations.
- Impact on daily life, including work capacity, mobility, and personal care.
For example, a cyclist with a 12% impairment from a car accident may qualify, but a pedestrian with a minor sprain would not. The PIC will also consider whether the injury meets the spinal nerve-root qualification (neurological signs beyond radiculopathy may still qualify).
Evidence Required for Disputes
To challenge a PIC decision, claimants must provide:
- Detailed medical records showing the injury's progression.
- Expert reports from specialists confirming the impairment percentage.
- Evidence of ongoing impact, such as work absence, reduced quality of life, or medical treatment costs.
- Documentation of the accident, including police reports or witness statements.
A hypothetical example: A Bega resident involved in a car accident with a fractured wrist and chronic pain may need a specialist to prove their impairment exceeds 10%.
Time Limits and Dispute Options
Claimants must notify the PIC of disputes within 52 weeks of the accident if they want to challenge the threshold assessment. After this period, benefits like weekly payments typically stop unless the injury is classified as a threshold injury. If the PIC denies a claim, claimants can request an internal review or seek independent medical opinion. However, a challenge does not guarantee a changed decision.
Practical Steps for Claimants
- Seek specialist medical assessment immediately after the accident.
- Document all treatment records and communicate with your doctor.
- Notify the PIC of any dispute within 52 weeks.
- Consult a solicitor if the PIC's decision is unsatisfactory.
Next Steps
CTP entitlements depend on the accident date, injury type, and claim history. To discuss your circumstances, complete the quick, no obligation enquiry form.