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 road accident that worsened a pre-existing injury, you may be eligible for compensation under NSW's Compulsory Third Party (CTP) scheme. This article explains how the NSW CTP scheme assesses claims where an existing medical condition is aggravated by a motor vehicle accident, with practical guidance for rural and remote claimants.
How the NSW CTP Scheme Handles Pre-existing Injuries
Under the Motor Accident Injuries Act 2017, the NSW CTP scheme covers injuries caused by road accidents, including those that worsen pre-existing conditions. However, the scheme requires proof that the accident aggravated the injury. SIRA (State Insurance Regulatory Authority) evaluates claims by determining whether the accident caused a new or worsened injury, not just a pre-existing one.
For example, if you had a history of back pain and a road accident caused increased pain or new neurological symptoms, this may qualify as an aggravated injury. SIRA's guidelines emphasize that the aggravation must be 'causally connected' to the accident, not merely coincidental.
Practical Steps and Evidence for Pre-existing Injury Claims
To support your claim, you'll need:
- Medical records showing your pre-existing condition and its connection to the accident
- Evidence of the accident (e.g., police reports, witness statements)
- Documentation of worsened symptoms or new injuries caused by the accident
- Proof of treatment and medical expenses related to the aggravation
In rural and remote NSW, access to specialist medical services may affect documentation. Ensure your treating doctor links the aggravation to the accident, as this is critical for SIRA's assessment.
Time Limits and Dispute Resolution
CTP claims must be made within 52 weeks of the accident for certain benefits, but this doesn't apply to all claims. If your injury is not a 'threshold injury' (as defined in the Motor Accident Guidelines), you may be eligible for ongoing compensation. Always check the specific time limits for your case.
If your claim is disputed, SIRA provides a formal review process. Rural claimants may need to seek legal advice to navigate this, as delays in submitting evidence can affect outcomes.
When to Seek Legal Advice
While SIRA handles many claims, complex cases involving pre-existing injuries may require a solicitor. A lawyer can help:
- Prove the aggravation was caused by the accident
- Navigate rural-specific challenges like limited access to specialists
- Ensure all documentation meets CTP scheme requirements
Example: A Rural Claimant's Case
Consider a farmer with a pre-existing knee injury who sustains additional damage in a rural road accident. His doctor documents worsened pain and reduced mobility linked to the accident. SIRA would assess whether the accident caused a new injury or worsened the existing one, determining eligibility for compensation.
Next Steps
CTP eligibility depends on the accident date, injury type, and claim history. Rural and remote claimants may face unique challenges, but the legal framework remains the same. To discuss your circumstances, complete the quick, no obligation enquiry form.