Preparing for Medical Assessments with Pre-existing Injuries
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 your pre-existing injury worsened after a motor accident, you may be eligible for compensation under NSW’s Compulsory Third Party (CTP) scheme. Medical assessments are critical to proving your claim, but they require careful preparation. This guide explains how to approach these assessments under the Motor Accident Injuries Act 2017 and SIRA’s guidelines.
Understanding SIRA’s Approach to Pre-existing Injury Claims
SIRA (State Insurance Regulatory Authority) evaluates claims where a pre-existing condition is aggravated by a motor accident. To succeed, you must demonstrate:
- A documented history of the pre-existing injury
- Evidence the accident worsened your condition
- Medical evidence linking the aggravation to the accident
SIRA’s guidelines emphasize that the aggravation must be ‘more than a minor increase in symptoms’ and must result in additional disability or treatment. For example, a pre-existing back injury that required surgery before the accident, but worsened to the point of needing further treatment, may qualify.
Practical Steps to Prepare for Medical Assessments
- Gather Comprehensive Medical Records
Provide all records showing your pre-existing injury, including diagnosis dates, treatment history, and any specialist reports. This helps establish the baseline condition before the accident.
- Document the Accident’s Impact
Note how your symptoms changed after the accident. For instance, if you experienced increased pain, reduced mobility, or new neurological symptoms, record these details.
- Prepare for the Assessment
Bring a list of questions for the medical professional. Ask them to explain how the aggravation affects your daily life and whether it meets SIRA’s threshold for additional compensation.
- Seek Independent Medical Opinion
If your claim is disputed, consider obtaining a second opinion from a specialist familiar with pre-existing injury cases. This can strengthen your evidence.
Time Limits and Dispute Resolution
You have 52 weeks from the accident date to claim benefits for threshold injuries (under s 4.4 of the Motor Accident Injuries Act 2017). For non-threshold injuries, time limits depend on the injury’s nature. If your claim is rejected, you may request a review with SIRA or seek legal advice to challenge the decision.
When to Seek Legal Advice
Consult a solicitor if:
- You’re unsure how to prove the aggravation
- Your claim is denied and you need to dispute the decision
- You need help navigating SIRA’s assessment process
Legal professionals can help you interpret medical reports and ensure your claim meets all statutory requirements.
Next Steps
CTP claims involving pre-existing injuries require careful documentation and legal strategy. To request contact about your circumstances, complete the quick, no obligation enquiry form.