How SIRA Assesses Pre-existing Injury Aggravation in NSW CTP Claims
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, NSW CTP insurers must determine whether the aggravation meets the scheme’s threshold for compensation. The key question is whether the accident caused a new injury or worsened an existing one to the point where daily activities are significantly impacted. Under the Motor Accident Injuries Act 2017, SIRA evaluates claims by assessing whether the aggravation results in a new injury that meets the scheme’s definition of a 'threshold injury' or leads to long-term functional limitations.
Proving Daily Activity Limitations from Pre-existing Injury Aggravation
To claim compensation for daily activity limitations caused by a pre-existing injury aggravated by an accident, claimants must provide evidence that:
- The pre-existing injury was documented in medical records before the accident
- The accident caused a measurable worsening of the injury
- Daily activities are now limited due to the aggravated condition
Medical evidence is critical. Doctors must link the aggravation to the accident and demonstrate how it affects the claimant’s ability to work, exercise, or perform routine tasks. SIRA’s Motor Accident Guidelines outline that functional limitations must be 'clinically significant' to qualify for benefits.
Key Differences Between Pre-existing and New Injuries
NSW CTP insurers treat pre-existing injuries differently from new injuries. For example:
- Pre-existing injuries must be aggravated by the accident to qualify for compensation
- New injuries must meet the threshold injury definition under the Motor Accident Injuries Act 2017
- Claims involving pre-existing injuries often require more detailed medical evidence to prove the aggravation
SIRA’s approach focuses on whether the accident caused a new injury or worsened an existing one to the point where the claimant’s daily life is meaningfully impacted. This distinction affects eligibility for treatment benefits, weekly income payments, and long-term compensation.
Practical Steps for Claimants with Pre-existing Injuries
If you have a pre-existing injury and believe an accident has aggravated it, take these steps:
- Document the pre-existing injury with medical records and a history of treatment
- Seek immediate medical attention after the accident to assess any new or worsened symptoms
- Request a specialist assessment to determine how the accident affected your condition
- Keep records of daily activity limitations and how they impact your life
Insurers may challenge claims by arguing the injury was not aggravated or that the aggravation is not clinically significant. Independent medical opinions are often required to resolve such disputes.
Time Limits and Dispute Resolution
NSW CTP claims must be submitted within 52 weeks of the accident unless an extension is granted. For pre-existing injury claims, the 52-week limit applies to benefits related to the aggravated injury. If the claim involves a new injury, the time limit applies to that specific injury.
Disputes over pre-existing injury aggravation can be resolved through:
- SIRA’s internal review process
- Independent medical assessments
- Mediation or arbitration
Claimants should seek legal advice if the insurer denies the claim or disputes the extent of the aggravation. A solicitor can help navigate the evidentiary requirements and ensure all medical records are properly submitted.
When to Seek Legal Advice
If your claim involves a pre-existing injury, it’s important to consult a lawyer early. SIRA’s guidelines are complex, and insurers often challenge these claims by questioning the link between the accident and the aggravation. A solicitor can:
- Help you understand your legal rights
- Ensure all necessary evidence is submitted
- Challenge unreasonable denials of your claim
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.