How SIRA Assesses Pre-existing Injury Aggravation Claims
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 an accident worsens a pre-existing medical condition, the New South Wales Compensation Tribunal (SIRA) evaluates claims based on whether the accident caused a new or increased injury. This is distinct from claims for new injuries. SIRA considers medical evidence to determine if the aggravation meets the threshold for compensation under the Motor Accident Injuries Act 2017.
Legal Framework for Pre-existing Injury Claims
- Under NSW CTP rules, a claimant must prove the accident caused a new injury or worsened an existing condition. SIRA uses the Motor Accident Guidelines to assess whether the aggravation results in
- new clinical signs* or
- increased impairment*. For example, if a pre-existing back injury becomes more severe after a car accident, medical records must show the aggravation caused additional pain, reduced mobility, or new neurological symptoms.
Practical Steps and Evidence Required
To support a claim, injured persons must provide:
- Medical records showing the pre-existing condition and its worsening after the accident
- Accident reports detailing how the incident occurred
- Witness statements or photographs of the scene
- Doctor's notes linking the aggravation to the accident
SIRA may require a medical expert report to confirm the aggravation caused new or increased impairment. For instance, a cyclist with a pre-existing knee injury who develops chronic pain after a collision would need a doctor to attest the aggravation caused lasting damage.
Time Limits and Dispute Resolution
- CTP claims must be submitted within 52 weeks of the accident, unless a
- genuine dispute* exists. If the claimant disputes SIRA's assessment, they can request a
- review* or apply to the NSW Civil and Administrative Tribunal (NCAT). However, time limits for disputes depend on the specific circumstances and evidence.
Common Pitfalls to Avoid
Claimants should avoid:
- Failing to document the pre-existing condition before the accident
- Not seeking medical attention after the accident
- Delaying claims beyond the 52-week deadline
- Providing incomplete or inconsistent evidence
For example, a pedestrian with a pre-existing ankle injury who ignores medical advice after a collision may struggle to prove the aggravation caused new impairment.
When to Seek Legal Advice
If a claimant is unsure whether their aggravation meets SIRA's criteria, or if their claim is rejected, they should consult a solicitor. Legal professionals can help navigate SIRA's assessment process, challenge decisions, or negotiate a fair outcome.
Next Steps
CTP claims involving pre-existing injuries require careful documentation and understanding of SIRA's evaluation standards. Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.