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 medical condition in New South Wales, claimants in Albury must navigate specific dispute resolution processes under the Motor Accident Injuries Act 2017. This article explains how SIRA assesses such claims, what evidence is required, and the options available to challenge a decision.
How SIRA Handles Pre-existing Injury Aggravation Claims
SIRA evaluates whether a motor accident has aggravated a pre-existing injury by assessing medical evidence. Under the Motor Accident Guidelines, aggravation must result in a 'threshold injury', defined as a condition requiring medical treatment and causing functional limitation. For example, if a claimant with a pre-existing knee injury experiences increased pain and reduced mobility after an accident, SIRA will review medical records to determine if the aggravation meets the threshold.
The key legal test is whether the aggravation is 'causally connected' to the accident. SIRA considers factors like the timing of the injury, medical reports, and the claimant’s history. If the aggravation is not clearly linked to the accident, the claim may be denied or limited to statutory benefits.
Evidence Needed to Prove Aggravation
To support a claim, claimants must provide:
- Detailed medical records showing the pre-existing condition and its progression
- A report from a medical practitioner linking the aggravation to the accident
- Evidence of how the aggravation impacts daily life (e.g., mobility, work capacity)
- Witness statements or accident reports confirming the incident
Medical evidence is critical. SIRA may require an independent medical opinion if there is disagreement about the cause of the aggravation. Claimants should ensure all documentation clearly shows the aggravation worsened the pre-existing condition.
Dispute Resolution Options in Albury
If a claim is rejected or limited, claimants in Albury have several options:
1. Internal Review by SIRA
Claimants can request a review of the decision within 28 days of receiving the notice. This involves a reassessment of the medical evidence and may result in a revised determination. SIRA’s internal review process is outlined in the Motor Accident Injuries Act 2017 s 4.4 and the Motor Accident Guidelines.
2. Personal Injury Commission (PIC) Review
If the internal review is unsatisfactory, claimants can apply to the PIC for a medical dispute review. The PIC will appoint an independent medical expert to assess whether the aggravation meets the threshold injury definition. This process is outlined in Schedule 2 of the Motor Accident Injuries Act 2017.
3. Legal Challenge
Claimants may seek legal advice to challenge SIRA’s decision through the NSW Civil and Administrative Tribunal (NCAT) or the Supreme Court. This is a last resort and requires evidence of legal errors in SIRA’s assessment.
Time Limits and Practical Steps
Claimants must submit their claim within 52 weeks of the accident (or 5 years for certain injuries) under the Motor Accident Injuries Act 2017 s 3.28. For disputes, the internal review must be requested within 28 days. Delaying these steps may reduce the chances of a successful outcome.
Example Scenario
A cyclist in Albury has a pre-existing ankle injury. After a motor accident, their condition worsens, requiring surgery. SIRA initially denies the claim, arguing the aggravation was not 'causally connected.' The claimant submits updated medical records showing the accident caused a fracture not present before. SIRA conducts an internal review, then refers the case to the PIC for a medical assessment. The PIC’s decision determines whether the aggravation meets the threshold injury definition.
When to Seek Legal Advice
Claimants should consult a solicitor if:
- SIRA denies the claim despite clear evidence of aggravation
- The PIC’s decision is unsatisfactory
- The claimant needs to challenge SIRA’s interpretation of the law
- There are disputes over medical evidence or causation
Legal professionals can help draft formal disputes, challenge SIRA’s medical opinions, and ensure all procedural requirements are met.
Next Steps
Disputes over pre-existing injury aggravation require careful documentation and timely action. Claimants in Albury should act quickly to preserve their rights under the Motor Accident Injuries Act 2017. Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.