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 a motor accident worsens a pre-existing injury, claimants in New South Wales must prepare carefully for medical assessments under the Compulsory Third Party (CTP) scheme. This guide explains how NSW law treats such claims, what evidence matters, and how to navigate medical evaluations to support your CTP compensation.
What is Pre-existing Injury Aggravation Under NSW CTP Laws?
Under the Motor Accident Injuries Act 2017 (MAIA), a pre-existing injury is aggravated if the accident causes a "material worsening" of the condition. This means the accident must have made the injury significantly worse than it was before. For example, a pre-existing back injury that required surgery before the accident could worsen after a crash, leading to new symptoms like chronic pain or mobility issues.
SIRA (State Insurance Regulatory Authority) guidance clarifies that insurers must assess whether the accident caused a "material worsening" by comparing the condition before and after the incident. Medical evidence is critical to prove this link.
How Do Insurers Assess Claims Involving Pre-existing Injuries?
Insurers evaluate claims by:
- Reviewing medical records from before and after the accident
- Consulting with medical practitioners to determine if the injury worsened
- Applying the MAIA's threshold injury rules (s 3.11 and 3.28) to assess if the aggravation meets compensation criteria
Claimants should anticipate that insurers will scrutinise the timeline of injuries and seek expert opinions to challenge the claim. SIRA's guidelines state that claimants must demonstrate a "direct and material worsening" caused by the accident.
What Evidence Should Claimants Gather?
To support a claim of pre-existing injury aggravation, gather:
- Full medical records from before the accident (including diagnoses, treatments, and recovery progress)
- Detailed accident reports from police or witnesses
- Statements from medical practitioners explaining how the accident worsened the condition
- Records of any pre-accident limitations or treatments
- Documentation of new symptoms or complications arising after the accident
Keep all records organised to show a clear progression from pre-existing condition to aggravated injury. SIRA advises that claimants must prove the aggravation "by a preponderance of the evidence".
How Does SIRA's Guidance Apply to These Scenarios?
SIRA's Motor Accident Claims page explains that claimants must provide evidence of a "material worsening" of a pre-existing condition. In practice, this means:
- Medical experts must confirm the aggravation
- The aggravation must be significant enough to affect daily life or work capacity
- The claimant must demonstrate that the accident caused the worsening, not natural progression of the injury
SIRA's What You Can Claim page notes that compensation may include treatment costs, income loss, and pain and suffering if the aggravation meets the threshold injury definition under the MAIA.
Practical Steps for Preparing for Medical Assessments
- Organise medical records: Ensure all pre-accident and post-accident records are complete and clearly show the worsening condition.
- Prepare for expert consultations: Work with your medical team to explain how the accident caused the aggravation.
- Document daily impact: Keep a journal of how the aggravated injury affects your ability to work, sleep, or perform daily tasks.
- Seek independent medical opinions: If the insurer disputes the claim, consider obtaining a second opinion from a specialist.
- Understand SIRA's assessment process: Familiarise yourself with how SIRA evaluates claims involving pre-existing injuries.
Example: Pre-existing Injury Aggravation in Practice
Consider a claimant with a pre-existing knee injury that required surgery in 2023. After a 2025 motor accident, they develop chronic pain and instability. Medical records show the accident caused a "material worsening" by exacerbating existing ligament damage. SIRA's guidelines would support a claim for treatment costs and income loss if the aggravation meets the threshold injury criteria.
Time Limits and When to Seek Advice
CTP claims must be submitted within 52 weeks of the accident under the MAIA. If the claim involves a pre-existing injury, time limits may be extended if the aggravation was not immediately apparent. However, delays can weaken the claim, so it's crucial to act promptly.
If you're unsure whether your claim meets the criteria for pre-existing injury aggravation, seek legal advice. A solicitor can help you:
- Navigate SIRA's assessment process
- Challenge unfair rejections of your claim
- Ensure you meet all legal requirements for compensation
Next Steps
CTP claims involving pre-existing injuries require careful preparation and evidence. By understanding the legal framework and gathering the right documentation, you can strengthen your case. If you need help preparing for medical assessments or assessing your claim, complete the quick, no obligation enquiry form to request contact about your circumstances.