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 a pillion passenger injured on a motorcycle in New South Wales, understanding how to resolve disputes over compensation or treatment funding is critical. Under NSW’s Compulsory Third Party (CTP) scheme, claimants have structured pathways to challenge decisions, though outcomes depend on the facts and evidence. This article explains the dispute resolution options available, how SIRA’s guidelines apply, and practical steps to take.
NSW CTP Rules for Pillion Passengers
The Motor Accident Injuries Act 2017 governs CTP claims, including those for pillion passengers. SIRA (State Insurance Regulatory Authority) administers the scheme, which covers injuries from motor vehicle accidents, including motorcycle incidents. Pillion passengers are entitled to treatment and care benefits, weekly income payments, and lump sum damages if eligible. However, disputes can arise over the scope of injuries, benefit calculations, or liability.
Dispute Resolution Options
- Internal Review: If you disagree with a decision about your claim, you can request an internal review from SIRA. This process allows claimants to provide additional evidence or challenge assessments of injury severity. For example, if SIRA determines your injuries are below the threshold for damages, you may submit medical records to contest this.
- Mediation: SIRA offers mediation as a step before formal dispute resolution. A neutral third party helps both sides reach an agreement without escalating to legal action. This is particularly useful for disputes over treatment funding or weekly benefit amounts.
- or Personal Injury Commission (PIC) Review: If a dispute involves a medical assessment, claimants can request a review by the PIC. This pathway is crucial for challenging decisions about whole person impairment ratings or the applicability of the 52-week benefit limit. Note that a PIC review does not guarantee a changed outcome and requires detailed evidence.
Practical Steps for Claimants
To resolve disputes effectively, gather the following:
- Medical records: Detailed documentation of injuries, treatments, and prognosis.
- Accident reports: Police reports, witness statements, and photographs of the scene.
- Income records: Proof of lost wages or reduced earning capacity.
- Correspondence: Emails or letters from insurers or SIRA that outline the dispute.
If you’re unsure whether your injuries meet the threshold for damages, seek clarification from SIRA. For example, a spinal nerve-root injury with neurological signs may qualify as a ‘threshold injury, ’ but radiculopathy requires specific clinical signs under the Motor Accident Guidelines.
Time Limits and Key Deadlines
CTP claims must be submitted within 52 weeks of the accident, though extensions may apply in exceptional cases. Disputes over benefits or liability must be resolved within this timeframe. If you miss a deadline, you may lose entitlements to weekly payments or treatment funding. Always confirm the exact deadline for your situation.
Example Scenario
Consider a pillion passenger who disputes the amount of weekly income payments. SIRA may have determined the claimant’s injuries are below the threshold for damages, but the passenger argues that ongoing pain and mobility issues justify higher payments. In this case, submitting updated medical evidence and a detailed income impact report could strengthen the claim.
When to Seek Legal Advice
Disputes over CTP claims can be complex, especially when involving medical assessments or the 52-week limit. If you’re unsure how to challenge a decision or need help gathering evidence, contact a solicitor specialising in NSW CTP claims. Legal advice can also help navigate the PIC review process or negotiate with SIRA.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.