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 a motor accident worsens a pre-existing injury, NSW CTP insurers must assess whether the aggravation is caused by the crash. This article explains how SIRA evaluates such claims, what evidence is needed to prove daily activity limitations on the Central Coast, and how to navigate this complex issue.
How NSW CTP insurers assess injury aggravation
NSW CTP insurers evaluate whether a pre-existing injury was worsened by a motor accident using the Motor Accident Guidelines and SIRA’s approach to aggravation claims. Under the Motor Accident Injuries Act 2017, insurers must determine if the crash caused a new or increased injury that affects daily activities. For example, if a person with a pre-existing back condition experiences worsened pain and mobility issues after a crash, this could qualify as aggravation.
Key factors include:
- Medical evidence showing a direct link between the accident and the worsened condition
- Pre-accident medical records to establish the existing injury
- Post-accident medical reports detailing new or heightened symptoms
- Evidence of daily activity limitations caused by the aggravation, such as difficulty with household tasks, work, or mobility
Evidence to prove daily activity limitations
To claim compensation for daily activity limitations caused by injury aggravation, you must provide:
- Medical documentation from a registered medical practitioner confirming the aggravation
- Statements from healthcare professionals explaining how the injury affects your ability to perform daily tasks
- Witness accounts or photographs of your limitations (e.g., difficulty walking, using stairs)
- Employer or school records showing reduced capacity to work or study
SIRA requires a clear connection between the accident and the worsened condition. For instance, if a cyclist with a pre-existing knee injury develops a meniscus tear after a crash, medical experts must confirm the tear was caused by the accident, not pre-existing degeneration.
SIRA’s approach to pre-existing injury claims
SIRA’s guidelines state that claims involving pre-existing injuries must demonstrate a causal link between the accident and the aggravation. This is distinct from claims based on new injuries. For example, if a pedestrian with a history of ankle surgery experiences instability after a crash, the insurer will assess whether the crash caused the instability or if it was due to the pre-existing condition.
In regional NSW, such as the Central Coast, claims may involve additional considerations, including access to specialist medical opinions and the need to establish the accident as the dominant factor in worsening the injury.
Time limits and when to seek advice
CTP claims must be made within 52 weeks of the accident if they involve only threshold injuries (soft tissue injuries). However, if the claim involves long-term impairment or requires a whole person impairment assessment, the time limit may be extended. It is critical to notify your insurer promptly and seek legal advice if you believe your claim is being undervalued or denied.
Practical steps for Central Coast residents
- Seek immediate medical attention after the accident to document any new or worsened symptoms.
- Keep all medical records and communicate with your healthcare provider about how the injury affects your daily activities.
- Notify your insurer within the required time frame and request a review of your claim.
- Consult a legal professional if you face disputes over the extent of your injuries or if your claim is rejected.
When to seek independent advice
If you are unsure whether your pre-existing injury was aggravated by the accident, or if your claim is being denied, it is essential to seek legal advice. A solicitor can help you:
- Navigate SIRA’s complex assessment process
- Challenge decisions that fail to account for aggravation
- Ensure your daily activity limitations are properly documented and valued
Next steps
CTP claims involving pre-existing injuries require careful documentation and legal expertise. If you are on the Central Coast and facing challenges with your claim, seek professional guidance to protect your rights. Every claim depends on its own facts, and the outcome may vary based on the evidence and legal interpretation.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.