How NSW CTP Law Handles Pre-existing Injury Aggravation
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).
In New South Wales, a motor accident claim can include compensation for injuries that worsened due to a crash, even if the person had a pre-existing condition. This is governed by the Motor Accident Injuries Act 2017 and SIRA’s guidelines. For example, a Bathurst resident with a pre-existing back injury who experiences increased pain after a car accident may qualify for compensation if the accident aggravated the condition.
Key Legal Principles for Pre-existing Injury Claims
- Under NSW CTP rules, insurers must assess whether the accident caused a
- new injury* or
- aggravated an existing one*. SIRA’s Motor Accident Guidelines clarify that aggravation requires a
- clear link* between the accident and the worsened condition. For instance, if a claimant’s pre-existing knee injury required surgery after a collision, the insurer must prove the accident did not cause the injury.
The burden of proof lies with the insurer to show the injury was not aggravated. This means claimants must provide evidence that the accident worsened their condition, not just caused a new one. SIRA’s approach emphasizes objective medical evidence to establish this link.
Evidence Needed to Prove Aggravation in Bathurst
To support a claim, claimants should gather:
- Medical records showing the pre-existing injury and its worsening after the accident.
- Accident reports detailing the incident’s circumstances.
- Witness statements from people who observed the accident.
- Expert opinions from medical practitioners confirming the aggravation.
For example, a Bathurst cyclist with a pre-existing wrist injury who sustained additional damage in a collision would need medical evidence showing the accident caused new symptoms, not just a temporary flare-up.
Time Limits and Dispute Resolution
CTP claims must be submitted within 52 weeks of the accident if the injury is a threshold injury (as defined by SIRA). However, if the injury is not a threshold injury, there is no strict time limit. Claimants should act quickly, as delays can weaken their case.
Disputes over aggravation are resolved by SIRA, which may request medical assessments or expert reports. Insurers must provide evidence that the injury was not aggravated, such as medical opinions showing no worsening.
When to Seek Legal Advice
Claimants should consult a solicitor if:
- The insurer denies the claim, citing lack of aggravation.
- Medical evidence is unclear or contested.
- The claimant needs help navigating SIRA’s process.
A lawyer can help challenge an insurer’s refusal and ensure all evidence is properly submitted.
Practical Example from Bathurst
Consider a Bathurst driver with a pre-existing herniated disc who experienced severe lower back pain after a minor car accident. Medical records showing pre-existing symptoms and new post-accident pain could support a claim. However, if the insurer argues the pain was due to a pre-existing condition, the claimant must prove the accident caused additional harm.
Next Steps for Claimants
If your injury worsened after a motor accident, gather medical evidence and contact your insurer. If your claim is denied, seek legal advice to challenge the decision. Time limits and legal complexities mean acting promptly is crucial.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.