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).
If a road accident worsens a pre-existing medical condition, NSW CTP insurers must assess whether the aggravation qualifies for compensation. This article explains how SIRA evaluates such claims, using practical examples from Ballina. It covers evidence requirements, time limits and when to seek legal advice.
How NSW CTP Law Handles Pre-existing Injury Aggravation
NSW CTP claims cover injuries caused or worsened by a motor accident. If a pre-existing condition is aggravated, insurers must determine whether the accident caused a new injury or worsened the existing one. SIRA's guidelines state that claimants must prove a direct link between the accident and the aggravation. For example, a person with a pre-existing back injury who experiences increased pain or disability after a crash may qualify for compensation.
Evidence Needed to Prove Pre-existing Injury Aggravation
To support a claim, injured persons must provide:
- Medical records showing the pre-existing condition and its progression
- Evidence of the accident, such as police reports or witness statements
- Medical opinions linking the accident to the worsened condition
- Documentation of treatment costs or lost income due to the aggravation
In Ballina, claimants should seek medical attention promptly and ensure all records clearly connect the accident to the aggravation. A doctor's report stating that the accident caused a 'significant worsening' of the condition is critical.
Time Limits and Dispute Options
CTP claims must be submitted within 52 weeks of the accident if the injury is a 'threshold injury' (a soft tissue injury meeting specific medical criteria). If the aggravation is not a threshold injury, time limits may vary. Claimants should act quickly to gather evidence and submit claims before deadlines. If an insurer disputes the claim, SIRA provides a formal review process to challenge decisions.
When to Seek Legal Advice
Complex cases involving pre-existing injuries often require legal assistance. A solicitor can help interpret SIRA guidelines, challenge denied claims, and ensure all evidence is properly submitted. In Ballina, claimants should consult a lawyer if they face disputes over the link between the accident and their worsened condition.
Practical Example from Ballina
Consider a Ballina resident with a pre-existing knee injury who experiences a flare-up after a car accident. Medical records showing worsening pain and reduced mobility post-accident, combined with a doctor's opinion that the accident aggravated the injury, would support a claim. SIRA would assess whether the aggravation meets the threshold injury criteria or qualifies as a new injury.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.