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).
If you're recovering from a motor accident and facing a PIC merit review about whether you can return to daily activities, understanding how SIRA assesses these claims is critical. In NSW, the Personal Injury Commission (PIC) reviews claims to determine if injuries prevent you from performing everyday tasks like cooking, shopping or managing personal care. This article explains how SIRA evaluates daily activity claims during PIC reviews in Illawarra and South Coast regions, what evidence matters, and when to seek legal advice.
How SIRA Evaluates Daily Activity Claims
SIRA uses the Motor Accident Guidelines to assess whether injuries prevent you from returning to daily activities. During a PIC merit review, claims are evaluated based on:
- Medical evidence showing how injuries affect your ability to perform tasks
- Statements from healthcare professionals about your functional capacity
- Activity logs or diaries documenting your daily challenges
SIRA considers whether your injuries meet the 'threshold injury' criteria under the Motor Accident Injuries Act 2017. For example, if you can no longer walk unaided or perform household chores, this may qualify as a threshold injury. However, SIRA may reduce or stop benefits if your injuries are deemed to have improved, even if you're not fully recovered.
Evidence Required for Daily Activity Claims
To support your claim during a PIC review, you'll need:
- Medical records showing the nature and severity of your injuries
- A doctor's report linking your injuries to daily activity limitations
- Activity logs or witness statements about your ability to perform tasks
- Evidence of how injuries impact your work, study or personal life
For example, if you're a student who can no longer attend classes due to chronic pain, your claim would need to show how your injuries prevent you from engaging in educational activities.
Regional Considerations in Illawarra and South Coast
While PIC review processes are consistent across NSW, regional claimants in Illawarra and South Coast may face unique challenges. These areas have fewer SIRA offices and limited access to specialist medical experts, which can delay reviews. Claimants should:
- Seek local solicitors familiar with regional PIC processes
- Request early medical assessments to establish injury timelines
- Document daily activities through photos, videos or written records
Time Limits and Dispute Resolution
You have 52 weeks from the accident date to claim certain benefits under the Motor Accident Injuries Act 2017. After this period, SIRA may stop weekly payments unless you can prove ongoing injuries. If you disagree with a PIC decision, you can:
- Request an internal review within 28 days of the decision
- Appeal to the NSW Civil and Administrative Tribunal (NCAT) within 28 days of the internal review
- Seek legal advice to challenge the decision through the courts
It's important to note that a PIC review does not guarantee a changed decision. SIRA has discretion to uphold or modify claims based on medical evidence and statutory guidelines.
When to Seek Legal Advice
If your PIC review is focusing on daily activities, consider consulting a solicitor who specialises in CTP claims. A lawyer can:
- Help you prepare evidence for SIRA
- Challenge decisions based on incorrect medical assessments
- Navigate regional process delays in Illawarra and South Coast
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.