Understanding the PIC Merit Review Process in NSW
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 have been injured in a motor accident in Greater Sydney and have received a decision from the Personal Injury Commission (PIC) that you believe is incorrect, you may be able to request a merit review. This is a formal process to have the PIC’s decision reviewed by a different decision-maker to determine whether the original decision was legally correct. The process applies to claims under the Motor Accident Injuries Act 2017 (MAIA), which is the current legal framework for Compulsory Third Party (CTP) compensation in New South Wales.
A merit review is not a new claim. It is a review of the PIC’s decision on a matter that has already been considered, such as the assessment of your injury, the level of weekly income payments, or the approval of treatment and care benefits. The review focuses on whether the decision was made according to the law and supported by the evidence, not on whether a different outcome would have been preferred.
Key Early Steps After Receiving a PIC Decision
If you have received a decision from the PIC that you dispute, the following steps should be taken as early as possible:
- Notify the insurer or the PIC in writing within 28 days of receiving the decision if you wish to request a merit review. This is a strict time limit.
- Gather and preserve all evidence that supports your position. This includes medical reports, treatment records, letters from your medical practitioner, proof of lost income, photographs of the accident scene or property damage, and any correspondence with the insurer or PIC.
- Review the reasons provided in the PIC’s decision letter. These will explain the legal basis for the decision and identify any gaps in the evidence that were considered.
- Consider whether you wish to seek independent medical evidence. If the PIC relied on a medical report that you believe is inaccurate or incomplete, obtaining a second opinion from a qualified medical practitioner may strengthen your case.
- Do not delay in acting. The 28-day window for requesting a merit review is strict and cannot be extended without a valid reason, such as a dispute over the date of receipt.
What to Expect During the Merit Review Process
The merit review is conducted by a different decision-maker within the PIC. The review is not a hearing. It is a written assessment of the original decision and the evidence on which it was based.
The review will focus on whether the original decision was legally correct and supported by the evidence. The decision-maker will not re-assess the facts or hear new evidence unless it was not available at the time of the original decision. You may be asked to provide additional information, but you are not entitled to a hearing or to present evidence in person.
If the review finds that the original decision was incorrect, it may be overturned or varied. If it finds that the decision was correct, it will be confirmed. The outcome will be communicated in writing.
Important Considerations for Injured Road Users in Greater Sydney
Injured road users, including pedestrians, cyclists, and passengers, are entitled to the same review rights as drivers. The location of the accident, whether in a car park, private driveway, or public road in Greater Sydney, does not affect eligibility for a merit review, provided the incident occurred in NSW and involved a motor vehicle.
The review process does not change the legal test for entitlement to benefits. For example, if your injury is classified as a threshold injury under the Motor Accident Injuries Act 2017, the PIC’s decision on whether you are entitled to damages will be assessed against the statutory threshold. The review will not alter this test.
A merit review does not guarantee a different outcome. The review is limited to checking whether the law was applied correctly and whether the evidence supported the decision. It is not a new determination of your injury or entitlement.
When to Seek Independent Advice
Given the complexity of the legal and medical issues involved, and the strict time limits, it is strongly recommended that you seek independent legal advice before requesting a merit review. A solicitor experienced in motor accident claims can help you assess whether the PIC’s decision was legally sound, identify gaps in the evidence, and advise on whether a review is likely to succeed.
For example, if you were injured as a pedestrian in a car park in Sydney and were denied weekly income payments because the PIC determined your injury did not prevent you from working, a review may be appropriate if you have medical evidence showing a significant impairment that affects your ability to perform daily tasks or return to work.
Next Steps
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.