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 suffered a new motor accident that worsens a pre-existing injury, you may be eligible for compensation under NSW's Compulsory Third Party (CTP) scheme. This article explains how SIRA assesses such claims, practical steps to prepare for medical assessments in Ashfield, and how to prove your injuries are aggravated by the new accident. Time limits and dispute resolution options are also outlined.
How SIRA Assesses Pre-existing Injury Aggravation
Under the Motor Accident Injuries Act 2017, SIRA evaluates whether a new accident has caused a 'material worsening' of a pre-existing condition. This involves:
- Medical evidence: Doctors must confirm the new accident caused a significant deterioration in your condition. For example, a pre-existing back injury that worsens after a crash may qualify if imaging shows new damage.
- Clinical signs: SIRA uses the Motor Accident Guidelines to determine if the aggravation meets the threshold for compensation. This includes assessing pain levels, mobility, and functional impairment.
- Expert reports: Independent medical opinions may be required to establish a causal link between the accident and the worsened injury.
Practical Steps to Prepare for Medical Assessments
To strengthen your claim, take these steps before your assessment:
- Gather medical records: Provide all documentation of your pre-existing injury, including diagnosis dates, treatment history, and previous specialist reports.
- Document the new accident: Keep records of the crash date, location, vehicle details, and any witness statements. Photos of the scene and vehicle damage are also important.
- Consult a specialist: Ensure your doctor is familiar with the Motor Accident Guidelines and can explain how the new accident has worsened your condition.
- Prepare a timeline: Clearly outline how your pre-existing injury has progressed before and after the new accident.
Proving Aggravation Under NSW Law
To succeed, you must show the new accident caused a 'material worsening' of your injury. This could include:
- Increased pain or reduced mobility compared to before the accident.
- New symptoms not present in your pre-existing condition (e.g., nerve damage after a previous injury).
- A deterioration in your ability to work or perform daily activities.
SIRA may require a second medical opinion to verify this. If your claim is denied, you can request a review or seek independent legal advice.
Time Limits and Dispute Resolution
CTP claims must be submitted within 52 weeks of the accident, unless an extension applies. If your injury is a 'threshold injury' (as defined by the Motor Accident Guidelines), benefits may stop after 52 weeks unless you can prove the aggravation is due to the new accident.
If you disagree with SIRA's decision, you can:
- Request a review by SIRA's internal team.
- Seek mediation through the NSW Civil and Administrative Tribunal (NCAT).
When to Seek Legal Advice
Complex cases involving pre-existing injuries often require legal assistance to:
- Navigate SIRA's assessment process.
- Challenge decisions based on incomplete or biased medical reports.
- Ensure all evidence is properly submitted within time limits.
Final Steps
Preparing for a medical assessment with a pre-existing injury requires careful documentation and expert medical evidence. If you're unsure how to proceed, contact a legal professional for guidance. Every claim depends on its own facts.