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 you were injured in a road accident and already had a pre-existing condition, you may wonder if your claim is affected. In New South Wales, the Motor Accident Injuries Act 2017 and SIRA’s guidelines determine how insurers assess claims where an existing injury is worsened by a crash. This article explains how SIRA evaluates aggravation, what evidence is needed, and practical steps for injured people in Ashfield.
How SIRA Assesses Pre-existing Injury Aggravation
SIRA considers whether the road accident caused a material worsening of your pre-existing condition. This means the injury must have become significantly more severe, painful, or functionally impaired as a result of the accident. For example, if you had a pre-existing knee injury and the crash caused a tear that required surgery, this could qualify.
Key factors include:
- Medical evidence showing the pre-existing condition and its worsening after the accident.
- Clinical records from doctors or specialists confirming the aggravation.
- Expert opinion from a medical professional linking the accident to the worsened injury.
SIRA does not automatically assume aggravation. You must prove the connection between the accident and the increased harm.
Evidence to Support Your Claim
To claim compensation for an aggravated pre-existing injury, you’ll need:
- Medical records detailing your pre-existing condition and its progression.
- Accident reports showing how the crash occurred.
- Witness statements or photographs of the scene.
- Income or employment records if the injury affects your ability to work.
- Correspondence with insurers or SIRA about your claim.
Your solicitor may need to request independent medical assessments to establish the link between the accident and the worsened injury.
Time Limits and Dispute Options
You have three years from the accident date to make a claim under NSW CTP laws. However, if your injury is classified as a threshold injury (e.g., soft tissue damage), benefits may be limited after 52 weeks under the Motor Accident Injuries Act 2017 s 4.4.
If your claim is disputed, you can:
- Request a review by SIRA.
- Seek independent expert opinions.
- Lodge a complaint with the NSW Civil and Administrative Tribunal (NCAT).
When to Seek Legal Advice
Talk to a solicitor if:
- Your pre-existing injury worsened significantly after the crash.
- You’re unsure if your claim meets SIRA’s criteria.
- You need help gathering medical or accident evidence.
- You want to understand how contributory fault might affect your claim.
A Hypothetical Example
Imagine a person with a pre-existing back injury who experiences increased pain and reduced mobility after a car accident. Their doctor confirms the injury has worsened, and imaging shows new damage. SIRA would assess whether the accident caused this aggravation, not just the original condition.
Next Steps
CTP claims involving pre-existing injuries depend on proving a direct link between the accident and worsened harm. To discuss your circumstances, complete the quick, no obligation enquiry form. Every claim depends on its own facts.