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 been in a motor accident and your existing medical condition worsened, you may be eligible for compensation under NSW's Compulsory Third Party (CTP) scheme. This guide explains how insurers assess aggravation claims, using practical examples from the Illawarra and South Coast regions. Key factors include medical evidence, the role of SIRA guidelines, and how regional claimants are treated under NSW law.
How SIRA Assesses Pre-existing Injury Aggravation
Under the Motor Accident Injuries Act 2017, SIRA (State Insurance Regulatory Authority) oversees CTP claims. To qualify for compensation, claimants must prove the accident aggravated a pre-existing injury. SIRA evaluates claims by:
- Medical evidence: Doctors must confirm the accident worsened the injury. For example, a back injury from a 2022 car crash in Wollongong may have been aggravated by a 2023 collision.
- Clinical signs: The injury must meet the 'threshold injury' definition in the Motor Accident Guidelines. This includes spinal nerve-root injuries with neurological signs.
- Causation: The accident must be the dominant cause of the worsened condition. SIRA considers whether the injury would have progressed without the accident.
Evidence Required for Aggravation Claims
Claimants must provide:
- Medical records showing the pre-existing injury and its worsening after the accident
- Accident reports detailing the incident's date, location, and circumstances
- Witness statements or police reports
- Statements from treating medical practitioners
In the Illawarra, claimants often need to demonstrate how the accident's force (e.g., a 2023 crash on the Princes Highway) specifically impacted their condition. South Coast claimants may face similar requirements but should note regional variations in medical opinion.
Practical Examples from Illawarra and South Coast
A 2023 case in Batemans Bay involved a cyclist with a pre-existing knee injury. After a collision with a car, medical experts confirmed the accident aggravated the injury beyond its original prognosis. SIRA approved treatment benefits under the CTP scheme.
In another example, a 2022 pedestrian in Jervis Bay with a history of ankle surgery claimed the accident worsened their mobility. SIRA required detailed imaging and a specialist report to establish aggravation.
Time Limits and When to Seek Advice
CTP claims must be submitted within 52 weeks of the accident, though extensions may apply for complex cases. If your injury worsened after this period, you may need to pursue a common law claim instead. Consult a legal professional if:
- Your pre-existing condition is unclear
- You're unsure if the accident caused worsening
- You face disputes over medical evidence
Next Steps
CTP entitlements depend on the accident date, injury type, and claim history. For tailored advice on Illawarra and South Coast claims, complete the quick, no obligation enquiry form. Every claim depends on its own facts.