Where a person's only injuries resulting from the accident are threshold injuries, weekly benefits and treatment and care generally cease after 52 weeks (ss 3.11 and 3.28).
If you were injured in a motor accident and already had a pre-existing condition, the 2017 reforms to NSW’s Compulsory Third Party (CTP) scheme changed how your claim is assessed. This article explains how pre-existing injuries are evaluated under the current rules, what changed in 2017, and how SIRA handles such cases. It also outlines practical steps for injured road users to take when dealing with these claims.
How Pre-existing Injuries Are Assessed in NSW CTP Claims
Under the Motor Accident Injuries Act 2017, claims involving pre-existing injuries must demonstrate that the motor accident aggravated the existing condition. This means the accident must have worsened the injury, not just coincided with it. For example, if you had a pre-existing back injury and the accident caused additional damage, you may be eligible for compensation.
SIRA (State Insurance Regulatory Authority) assesses claims by requiring medical evidence to show the aggravation. This includes:
- Medical records showing the pre-existing injury
- Evidence that the accident caused additional harm
- A report from a medical practitioner linking the aggravation to the accident
The 2017 reforms clarified that pre-existing injuries are only compensable if the accident caused a new or worsened condition. This changed from earlier interpretations where some claims were accepted without proving aggravation.
Key Changes Introduced by the 2017 Reforms
The 2017 reforms focused on making CTP claims more transparent and evidence-based. Key changes affecting pre-existing injury claims include:
1. Aggravation Must Be Proven
The reforms require claimants to prove the motor accident directly caused the aggravation. This means the injury must have worsened as a result of the accident, not just occurred at the same time. For example, if a pre-existing knee injury flared up after an accident, the claimant must show the accident caused the flare-up.
2. Threshold Injury Rules Apply
If the aggravation results in a threshold injury (as defined in the Motor Accident Guidelines), the claimant may be eligible for statutory benefits. Threshold injuries include conditions like whiplash, soft tissue injuries, or spinal nerve-root injuries. However, if the aggravation does not meet the threshold, the claim may be limited to the new injury.
3. SIRA’s Role in Assessing Aggravation
SIRA now requires detailed medical reports to assess whether the aggravation meets the threshold. This includes:
- Documentation of the pre-existing injury
- Evidence of the accident’s impact
- A medical opinion on the aggravation’s link to the accident
These changes mean claimants must provide stronger evidence to prove aggravation, compared to pre-2017 rules.
Practical Steps for Injured Road Users
If you have a pre-existing injury and were involved in a motor accident, take these steps:
1. Seek Immediate Medical Attention
Even if you feel fine after the accident, seek medical attention to document any new or worsened symptoms. This is critical for proving aggravation.
2. Keep Detailed Records
Gather all relevant documents, including:
- Medical records showing the pre-existing injury
- Police reports or accident statements
- Witness statements
- Photos of the accident scene
- Correspondence with insurers
3. Notify Your Insurer Promptly
Inform your insurer about the pre-existing injury and the accident. Delaying notification may affect your claim.
4. Consult a Specialist
A medical practitioner with expertise in trauma or musculoskeletal injuries can provide a report linking the aggravation to the accident. This is often required for SIRA to assess your claim.
Time Limits and Dispute Options
CTP claims must be made within 52 weeks of the accident under the Motor Accident Injuries Act 2017. If the claim involves a pre-existing injury, the 52-week limit still applies to the aggravation. However, if the aggravation results in a threshold injury, benefits may continue beyond 52 weeks depending on the severity.
If your claim is disputed, you can request a review by SIRA. You may also seek independent legal advice to challenge a decision or negotiate a better outcome.
When to Seek Legal Advice
If you’re unsure whether your claim meets the aggravation criteria, or if SIRA has rejected your claim, it’s important to consult a solicitor. A lawyer can help you:
- Gather the right evidence
- Challenge a decision
- Negotiate a fair settlement
- Understand your rights under the current CTP scheme
Conclusion
The 2017 reforms to NSW’s CTP scheme have made it more difficult to claim compensation for pre-existing injuries unless the accident clearly aggravated the condition. SIRA now requires strong medical evidence to support such claims. If you’re involved in a motor accident with a pre-existing injury, take steps to document the aggravation and seek professional advice to protect your rights.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.