Pre-existing injury aggravation, scheme eligibility basics (Greater Sydney)
If you've had a pre-existing injury that worsened after a motor accident, you may be eligible for compensation under the NSW Compulsory Third Party (CTP) scheme. This article explains how the scheme assesses claims where an existing injury is aggravated by a new accident, what evidence is needed, and the practical steps to take in Greater Sydney.
How the NSW CTP scheme handles pre-existing injury aggravation
Under the Motor Accident Injuries Act 2017, the NSW CTP scheme provides compensation for injuries caused by motor accidents. However, if your injury was already present before the accident and was made worse by the crash, the scheme has specific rules to determine your eligibility.
SIRA (State Insurance Regulatory Authority) assesses whether the aggravation of your pre-existing injury was caused by the motor accident. This involves a detailed evaluation of your medical history, the nature of the accident, and the impact on your condition. The key question is whether the accident caused a significant worsening of your injury, beyond what was already present.
What evidence is needed to prove pre-existing injury aggravation
To support your claim, you'll need to provide evidence that:
- Your injury existed before the accident
- The accident caused a significant worsening of your condition
- The worsening has resulted in additional pain, disability, or loss of function
Medical records are crucial. Your doctor or specialist should document the pre-existing injury, the accident, and the resulting aggravation. You may also need to provide details of the accident, such as the date, location, and circumstances, to establish a connection between the incident and your worsened condition.
Practical steps to take after an aggravating accident
If you believe your pre-existing injury has been aggravated by a motor accident, take the following steps:
- Seek medical attention immediately after the accident to document the worsening condition
- Keep a record of all medical treatments, appointments, and correspondence
- Gather evidence of the accident, such as witness statements, photographs, and police reports
- Contact your insurer or SIRA to start the claims process
It's important to act quickly, as there are time limits for making claims under the NSW CTP scheme. You should also be aware that the scheme has specific rules for claims involving pre-existing injuries, which may affect your eligibility for certain benefits.
Time limits, disputes and when to seek advice
Under the NSW CTP scheme, you generally have 52 weeks from the date of the accident to make a claim for treatment and care benefits. If your claim involves a dispute or if you're unsure about your eligibility, it's important to seek legal advice as soon as possible.
If your claim is rejected, you may have the right to appeal the decision. SIRA provides a process for reviewing claims, and you may need to provide additional evidence or clarification to support your case.
When to seek independent legal advice
If your claim involves complex medical or legal issues, or if you're unsure about your eligibility, it's advisable to seek independent legal advice. A solicitor can help you understand your rights, prepare your claim, and ensure that you meet all the requirements of the NSW CTP scheme.
How to request contact about your circumstances
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.