Pre-existing Injury Aggravation, What Changed After 2017 Reforms in Western Sydney
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).
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 suffered a pre-existing injury that worsened after a motor accident, the NSW CTP scheme’s rules have evolved since 2017. The reforms introduced by the Motor Accident Injuries Act 2017 now require claimants to prove the accident aggravated their condition, not just caused a new injury. This shift impacts how claims are assessed, especially in Western Sydney, where SIRA (State Insurance Regulatory Authority) handles most cases.
How SIRA Assesses Pre-existing Injury Aggravation
Under the current scheme, SIRA evaluates whether the motor accident caused a new injury or worsened an existing one. For example, if you had a pre-existing knee condition and the accident caused additional damage, the claim must demonstrate the accident’s role in the aggravation. Key factors include:
- Medical evidence showing the existing injury and its worsening after the accident.
- Accident reports linking the incident to the aggravation.
- Witness statements or expert opinions confirming the connection.
- SIRA’s guidelines now emphasize that the aggravation must be
- more than a temporary worsening*; it must result in a
- new or increased impairment*. This distinction is critical for claims involving chronic conditions like back pain or arthritis.
Practical Steps for Claimants in Western Sydney
To build a strong claim, take these steps:
- Document the pre-existing injury with medical records, including dates of diagnosis and treatment.
- Preserve accident details like police reports, photos, and witness contact information.
- Seek medical attention after the accident to establish a link between the incident and the aggravation.
- Notify your insurer promptly, as delays may affect benefit eligibility.
For instance, if you had a pre-existing herniated disc and the accident caused nerve damage, your claim must show the accident exacerbated the condition beyond its original state.
Time Limits and Dispute Options
- Claims must be made within 52 weeks of the accident if they involve only
- threshold injuries* (minor soft-tissue injuries). However, if the aggravation results in a
- threshold injury*, benefits may still be available beyond this period. For more severe injuries, time limits depend on the nature of the impairment.
If your claim is disputed, you can request a review by SIRA or seek mediation through the NSW Civil and Administrative Tribunal (NCAT). Legal advice is recommended if the insurer rejects your claim or disputes the aggravation.
When to Seek Legal Advice
The 2017 reforms introduced stricter criteria for proving aggravation, making it essential to consult a solicitor if:
- Your injury worsened after a car accident, pedestrian collision, or other motor incident.
- You have a history of pre-existing conditions.
- The insurer denies your claim or disputes the connection to the accident.
A lawyer can help you gather evidence, challenge rejections, and ensure you meet the legal threshold for compensation.
Next Steps
CTP claims involving pre-existing injuries require careful documentation and legal understanding. The 2017 reforms mean that proving aggravation is now central to your case. If you’re in Western Sydney and need guidance on how to proceed, complete the quick, no obligation enquiry form to request contact about your circumstances.