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 you've suffered a motor accident in Ashfield that worsened a pre-existing injury, you may be eligible for compensation under NSW's Compulsory Third Party (CTP) scheme. This guide explains how to document your claim, what evidence is required, and how SIRA evaluates such cases. Time limits and dispute options are also covered.
Proving Pre-existing Injury Aggravation Under NSW CTP Rules
- Under the Motor Accident Injuries Act 2017, claims for pre-existing injuries aggravated by a motor accident require clear evidence that the accident caused a
- material worsening* of your condition. SIRA's guidelines state that the aggravation must be
- more than temporary* and result in additional pain, disability, or treatment needs.
Key legal principles include:
- Threshold injury rules: If your pre-existing injury was already a 'threshold injury' (as defined in the Motor Accident Guidelines), the aggravation must meet the same clinical criteria.
- Causation requirement: You must prove the accident caused the worsening, not just coincided with it.
- No-fault basis: CTP claims are not based on who was at fault, but on whether the accident aggravated your existing condition.
Essential Documentation Checklist for Pre-existing Injury Claims
To support your claim, gather these documents:
- Medical records: Show the pre-existing injury's history, including dates of diagnosis, treatments, and how the accident worsened it.
- Accident report: Obtain a police report or statement detailing the incident's date, time, location, and circumstances.
- Witness statements: Include accounts from people who saw the accident or noticed changes in your condition.
- Medical expert opinion: A doctor's report confirming the aggravation meets SIRA's clinical criteria.
- Photographs: Document visible injuries or damage to your vehicle.
- Income and treatment records: Show how the aggravation impacted your ability to work or required additional care.
Practical Steps for Injured Individuals in Ashfield
- Seek immediate medical attention after the accident, even if you feel fine. Document all treatments and note how the injury worsens over time.
- Notify your insurer within 52 weeks of the accident, as SIRA limits benefits for injuries that don't meet threshold criteria after this period.
- Consult a medical expert to assess whether the aggravation meets SIRA's clinical standards.
- Keep all records related to the accident, including police reports, medical bills, and correspondence with insurers.
Time Limits and Dispute Options
You have 52 weeks from the accident date to notify SIRA of your claim. If your injury doesn't meet threshold criteria, benefits may stop after this period. If you disagree with SIRA's decision, you can:
- Request a review through SIRA's internal process.
- Appeal to the NSW Civil and Administrative Tribunal (NCAT).
- Seek legal advice if the dispute involves complex medical or legal issues.
When to Seek Legal Advice
Talk to a solicitor if:
- Your claim is being denied due to lack of evidence.
- You're unsure whether the aggravation meets SIRA's criteria.
- You need help navigating the 52-week time limit.
- You want to dispute a decision about your benefits.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.