If a motor accident aggravates a pre-existing injury, claimants in New South Wales must prove the connection between the accident and the worsened condition. Under the Motor Accident Injuries Act 2017 (MAIA), claims involving pre-existing injuries require specific documentation to establish that the accident caused or worsened the injury. This article explains the legal requirements, evidence needed, and steps to strengthen your claim.
Legal Framework for Pre-existing Injury Claims
NSW CTP claims involving pre-existing injuries are governed by the MAIA and SIRA guidelines. SIRA (State Insurance Regulatory Authority) assesses whether the accident caused or aggravated an existing condition. Key principles include:
- Aggravation must be proven: The accident must have worsened the pre-existing injury, not merely coincided with it. This requires medical evidence showing a causal link.
- Threshold injury rules: If the aggravation results in a threshold injury (e.g., soft tissue injury), the claim may be limited to statutory benefits under the MAIA. SIRA evaluates whether the aggravation meets the threshold injury definition in the Motor Accident Guidelines.
- No fault requirement: CTP claims do not depend on who was at fault. However, the accident must have directly contributed to the worsened condition.
Essential Documentation Checklist
To support a claim of pre-existing injury aggravation, claimants must gather specific evidence. Key documents include:
- Medical records: Obtain records from before and after the accident. This includes:
- Pre-accident diagnosis and treatment history
- Post-accident medical reports detailing worsened symptoms
- Imaging (e.g., MRI, X-rays) showing changes
- Accident details: Provide a clear account of the incident, including:
- Date, time, and location
- How the injury was aggravated (e.g., sudden movement, impact)
a witness statement if available
- Pre-existing injury evidence: Prove the injury existed before the accident. This may include:
- Doctor’s notes from before the accident
- Past treatment records
- Statements from healthcare providers
- Medical opinion: A specialist report linking the accident to the worsened condition is critical. SIRA may require a report from a registered medical practitioner confirming the aggravation.
Steps to Build a Strong Case
- Seek immediate medical attention: Document all post-accident treatments. Even if symptoms appear minor, delayed treatment can weaken the claim.
- Notify your insurer: Inform the at-fault driver’s CTP insurer about the pre-existing injury. Failure to disclose may affect claim processing.
- Consult a medical expert: A specialist can provide an independent opinion on whether the accident caused or worsened the injury.
- Keep a symptom diary: Record changes in pain, mobility, or function after the accident. This can help establish a timeline of worsening.
- Review SIRA guidelines: Familiarise yourself with SIRA’s What you can claim to understand how pre-existing injuries are assessed.
Time Limits and Dispute Resolution
CTP claims must be submitted within 52 weeks of the accident, unless an extension is granted. If the claim involves a pre-existing injury, time limits may apply to statutory benefits (e.g., weekly payments). Disputes over aggravation may require:
- Medical expert reports to clarify causation
- SIRA review processes to challenge an initial decision
- Legal advice if the claim is denied or disputed
Example Scenario
A cyclist with a pre-existing knee injury sustains a fall that worsens the condition. Medical records show the injury was stable before the accident but worsened after. SIRA evaluates whether the fall caused a new threshold injury. If the aggravation meets the threshold definition, the claimant may receive weekly payments and treatment benefits.
When to Seek Legal Advice
Complex cases involving pre-existing injuries may require legal assistance. A solicitor can:
- Navigate SIRA’s assessment process
- Challenge decisions based on incomplete or incorrect information
- Ensure all documentation meets legal standards
Next Steps
CTP claims involving pre-existing injuries depend on proving a direct link between the accident and worsened condition. To request contact about your circumstances, complete the quick, no obligation enquiry form.