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 a motor accident worsens a pre-existing injury, it may affect your ability to return to daily activities in the Blue Mountains or Nepean. Under NSW CTP laws, claims involving pre-existing injuries require proof that the accident aggravated the condition. This article explains how SIRA assesses such claims, what evidence is needed, and how regional factors may influence outcomes.
How NSW CTP Law Handles Pre-existing Injury Aggravation
NSW CTP claims are governed by the Motor Accident Injuries Act 2017 and SIRA guidelines. If a pre-existing injury is aggravated by a motor accident, the claimant may be eligible for benefits covering daily activity limitations. However, the law requires proof that the accident caused or worsened the injury. SIRA considers factors like medical records, pre-accident functionality, and post-accident restrictions to determine if the aggravation is significant enough to qualify for compensation.
Evidence Needed to Prove Daily Activity Limitations
To support a claim, you must provide evidence linking the accident to your current limitations. Key documents include:
- Medical records showing the pre-existing injury and its worsening after the accident
- A doctor's report detailing how the injury affects daily activities
- Evidence of pre-accident functionality (e.g., work records, activity logs)
- Witness statements or accident reports confirming the incident
SIRA may also request a medical assessment to evaluate the connection between the accident and your condition.
SIRA Guidelines and Regional Considerations
SIRA's guidelines emphasize that aggravation must result in a 'threshold injury', a defined level of harm under the Motor Accident Injuries Act 2017. For example, if a pre-existing back injury worsens to the point of requiring mobility aids, this may qualify. Regional factors like access to healthcare in the Blue Mountains or Nepean may influence treatment timelines, but NSW law applies uniformly. Claims in these areas must still meet the same evidentiary standards as elsewhere.
Practical Steps and When to Seek Advice
- Seek immediate medical attention after the accident, ensuring records document both the pre-existing injury and its worsening
- Preserve accident details, including photos, witness contacts, and insurance correspondence
- Complete the SIRA claim form within 52 weeks of the accident, as benefits for threshold injuries may be limited after this period
- Consult a solicitor if disputes arise over the extent of aggravation or if your daily activities are significantly impacted
Disputes often occur when insurers dispute the link between the accident and the injury. Legal advice is crucial if your claim is rejected or if you need to challenge a decision.
Example: Pre-existing Injury Aggravation in Practice
Consider a cyclist with a pre-existing knee injury who crashes and develops chronic pain limiting their ability to walk. Medical evidence showing the crash worsened the injury, combined with pre-accident activity records, would support a claim. SIRA would assess whether the aggravation meets the threshold injury criteria and whether daily activities are genuinely restricted.
Time Limits and Next Steps
NSW CTP claims must be submitted within 52 weeks of the accident, though extensions may apply in exceptional circumstances. If your claim involves pre-existing injuries, act quickly to gather evidence and notify insurers. For complex cases, legal advice can help navigate disputes over aggravation and entitlements.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.