How SIRA Assesses Claims Where a Road Accident Worsens a Pre-existing Injury
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 road accident and your existing medical condition has worsened, you may be eligible for compensation under NSW's Compulsory Third Party (CTP) scheme. SIRA (State Insurance Regulatory Authority) evaluates these claims by determining whether the accident caused a material worsening of your pre-existing injury. This article explains how SIRA assesses such cases, what evidence is needed, and practical steps for injured people in Balmain.
Key Legal Framework for Pre-existing Injury Aggravation
Under the Motor Accident Injuries Act 2017, claims involving pre-existing injuries must demonstrate that the road accident caused a significant deterioration in your condition. SIRA applies the Motor Accident Guidelines to assess whether the aggravation meets the threshold for compensation. For example, if you had a pre-existing back injury and the accident caused new nerve damage or increased pain, this could qualify as an aggravation.
Importantly, SIRA distinguishes between:
- New injuries caused by the accident
- Aggravation of a pre-existing condition
- No change in your condition due to the accident
If the injury worsened, you may be entitled to treatment benefits, weekly payments, or lump sum damages depending on the severity.
Evidence to Support a Claim of Injury Aggravation
To prove that your pre-existing injury was aggravated by the accident, you must provide:
- Medical records showing your condition before and after the accident
- Doctor's reports linking the accident to the worsening injury
- Accident details (e.g., police reports, witness statements)
- Evidence of impact (e.g., photographs of the vehicle damage)
SIRA will review these documents to determine if the accident caused a material worsening of your condition. For instance, if your pre-existing injury required surgery before the accident but worsened to the point of needing further treatment, this could support a claim.
How Pre-existing Injury Aggravation Affects Compensation
If your injury was aggravated by the accident, you may be eligible for:
- Treatment and care benefits (up to 52 weeks)
- Weekly income payments if the aggravation caused you to stop working
- Lump sum damages if the aggravation results in long-term impairment
However, if your injury did not worsen, you may not be entitled to benefits. SIRA will assess whether the aggravation meets the threshold injury criteria under the Motor Accident Guidelines.
Practical Steps for Injured People in Balmain
- Seek immediate medical attention to document the worsening injury
- Preserve all accident-related evidence (e.g., medical records, accident reports)
- Notify your insurer about the aggravation as soon as possible
- Consider legal advice if your claim is disputed or you need help with documentation
If you're unsure whether your injury qualifies as aggravated, contact a legal professional in Balmain. SIRA's guidelines are strict, and evidence must clearly show a link between the accident and the worsening condition.
Time Limits and When to Seek Advice
You have 52 weeks from the accident date to claim treatment and care benefits under the CTP scheme. If your injury worsened after this period, you may need to pursue a separate claim for long-term impairment. Always consult a lawyer if your claim is denied or if you're unsure about your entitlements.
Next Steps
CTP claims involving pre-existing injuries require careful documentation and legal understanding. If you're in Balmain and need help with your claim, complete the quick, no obligation enquiry form to request contact about your circumstances.