If you've suffered a motor accident that worsened a pre-existing injury, resolving compensation disputes in NSW requires understanding how SIRA assesses aggravation and the options available. This article explains the legal framework, evidence needed, and steps to challenge a CTP insurer's decision in Ashfield.
How SIRA Assesses Pre-existing Injury Aggravation
SIRA evaluates whether a motor accident has aggravated a pre-existing condition by reviewing medical evidence. Under the Motor Accident Injuries Act 2017, insurers must determine if the accident caused a new injury or worsened an existing one. This involves:
- Medical records: Doctors must document pre-existing conditions and how the accident impacted them.
- Clinical signs: SIRA uses the Motor Accident Guidelines to assess whether neurological signs or functional loss resulted from the accident.
- Expert reports: Independent medical opinions may be required to confirm aggravation.
For example, if a person with a pre-existing back injury experiences increased pain and reduced mobility after a crash, SIRA will compare pre- and post-accident medical records to determine if the accident caused a new or worsened condition.
Dispute Resolution Options for Pre-existing Injury Claims
If your claim is denied or reduced, you can challenge the decision through:
- Internal review: Most insurers allow a written request for reconsideration within 28 days of the decision. This is free and does not require legal representation.
- Personal Injury Commission (PIC) review: If the internal review is unsatisfactory, you can apply to the PIC for a medical dispute review. The PIC will appoint a medical expert to assess whether the injury was aggravated.
- Mediation or litigation: If disputes persist, you may seek mediation through the NSW Civil and Administrative Tribunal (NCAT) or pursue a court claim. Legal advice is essential at this stage.
Practical Steps for Claimants in Ashfield
To strengthen your case:
- Preserve medical records: Ensure all pre-accident and post-accident records are complete and clearly show the injury's progression.
- Document the accident: Gather witness statements, police reports, and photographs of the scene.
- Seek independent medical advice: A second opinion can help demonstrate that the accident aggravated your condition.
- Act quickly: SIRA has 28 days to respond to internal review requests, and time limits apply for PIC applications.
When to Seek Legal Advice
Disputes over pre-existing injuries often require specialist knowledge of SIRA's assessment criteria and the legal steps to challenge decisions. A solicitor can help you:
- Navigate the PIC review process.
- Challenge the validity of an insurer's medical opinion.
- Pursue compensation for aggravated injuries.
Time Limits and Key Deadlines
- Internal review: Must be requested within 28 days of the insurer's decision.
- PIC application: Must be submitted within 28 days of the internal review outcome.
- Court action: Can be initiated within 6 months of the insurer's final decision, though this is rare for pre-existing injury claims.
Final Steps for Claimants
If your claim is contested, the first priority is to request an internal review and submit all relevant evidence. If the insurer denies your claim, the PIC review is the next step. Legal advice is strongly recommended to ensure you meet all procedural requirements and present your case effectively.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.