If a motor accident worsens a pre-existing injury, New South Wales' Compulsory Third Party (CTP) scheme determines compensation based on whether the accident caused new or aggravated injuries. This article explains how to resolve disputes over such claims in the Blue Mountains and Nepean, focusing on SIRA's processes, medical evidence requirements, and legal options.
What Counts as a Valid Claim
Under the Motor Accident Injuries Act 2017 (MAIA), a claimant must prove the accident caused new injuries or worsened existing ones. A 'threshold injury' includes soft tissue injuries (like whiplash) or psychological injuries such as adjustment disorder or acute stress disorder (s 1.6). If the aggravation meets this threshold, claimants may qualify for treatment benefits, weekly payments, or lump sum damages. However, if the injury is below the threshold, statutory benefits may be limited.
Disputes Over Pre-existing Injuries
In regional areas like the Blue Mountains and Nepean, resolving disputes typically involves:
- Internal review by SIRA: Claimants can request a reassessment of their claim, providing new medical evidence or clarifying how the accident worsened their condition.
- Medical dispute pathway: If SIRA disputes the link between the accident and the aggravation, the Personal Injury Commission (PIC) can arrange an independent medical opinion to determine if the injury meets the threshold criteria.
- Legal review: Lawyers can help identify gaps in medical records or challenge SIRA's assessment, particularly if the claimant is unsure about their eligibility.
Evidence to Support Your Claim
To strengthen a claim involving a pre-existing injury, injured individuals should:
- Document the pre-existing condition: Provide medical records, diagnosis dates, and treatment history to establish the injury's baseline.
- Obtain post-accident medical evidence: A doctor's report linking the accident to worsened symptoms is critical. This may include imaging, physical exams, or specialist opinions.
- Submit detailed claim forms: SIRA's claim form requires specific information about the pre-existing injury and how the accident aggravated it. Incomplete forms may delay processing.
Time Limits and Next Steps
CTP claims must be submitted within 52 weeks of the accident, unless an extension is granted. However, disputes over pre-existing injuries often require prompt action, as delays can hinder evidence collection. For example, if a claimant waits too long to seek medical attention, a doctor may not be able to establish a clear link between the accident and the aggravation.
If the claimant is unsure about their eligibility or faces a dispute, seeking legal advice early is advisable. A lawyer can help determine whether the aggravation meets the threshold injury criteria and whether the claimant is entitled to additional benefits beyond statutory payments.
Example Scenario
Consider a cyclist with a pre-existing knee injury who crashes into a car. The accident causes swelling and pain that worsens the existing condition. The cyclist submits medical records showing the pre-existing injury and a doctor's report linking the crash to increased symptoms. SIRA assesses the claim and determines that the aggravation meets the threshold injury criteria, resulting in treatment benefits and weekly payments. However, if SIRA disputes the link, the cyclist can request a review or seek an independent medical opinion to support their case.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.