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 a motor accident worsens a pre-existing injury, claimants in Ashfield must navigate specific rules under NSW's Compulsory Third Party (CTP) scheme. This article explains how SIRA assesses such claims, outlines common errors to avoid, and provides practical steps to strengthen your case.
How SIRA Handles Pre-existing Injury Aggravation
Under the Motor Accident Injuries Act 2017, SIRA evaluates whether an accident aggravates a pre-existing condition. Key factors include:
- Medical evidence showing the accident caused a new or worsened injury.
- Documentation of the pre-existing condition, such as medical records from before the accident.
- Causation, proof that the accident, not pre-existing factors, led to the new injury.
SIRA's guidelines stress that claimants must demonstrate a 'direct link' between the accident and the aggravated injury. Failure to establish this can result in claims being denied or limited to statutory benefits only.
Common Mistakes to Avoid
- Not informing insurers about pre-existing injuries. Failing to disclose a known condition may invalidate claims. Insurers must be told about all relevant medical history.
- Delaying medical treatment. Delayed care can weaken evidence of the accident's role in worsening the injury. Seek medical attention promptly after the accident.
- Ignoring SIRA's requirements for 'aggravation'. SIRA requires specific clinical signs (e.g., increased pain, new neurological symptoms) to prove aggravation. General claims about worsening injuries are often rejected.
- Failing to preserve evidence. Keep all medical records, accident reports, and witness statements. Disputes often hinge on whether evidence supports a causal link.
Practical Steps to Strengthen Your Claim
- Document the pre-existing injury with medical records and a doctor's statement.
- Report the accident to SIRA immediately. Delays can jeopardize claims, especially if injuries worsen over time.
- Seek independent medical opinions if there's disagreement about the injury's cause.
- Avoid admitting fault. CTP claims are based on the accident's impact, not who was at fault.
Time Limits and When to Seek Advice
CTP claims must be submitted within 52 weeks of the accident, though extensions may apply for complex cases. If your injury worsens after the initial 52-week period, you may still claim for new injuries caused by the accident. However, claims for pre-existing injuries that have not been aggravated are generally limited to statutory benefits.
Example: A Common Pitfall
Consider a claimant with a pre-existing knee injury who sustains a new injury in a car accident. If they fail to inform SIRA about the prior knee condition and only report the new injury, the claim may be denied. SIRA would argue the new injury is not 'aggravated' because the pre-existing condition was not disclosed.
Next Steps
CTP claims involving pre-existing injuries require careful attention to medical evidence and procedural deadlines. If you're in Ashfield and unsure how to proceed, seek advice from a solicitor experienced in SIRA claims. General information cannot determine whether a claim is available in an individual case. Time limits and procedural requirements may apply. To request contact about the next step, complete the quick, no obligation enquiry form.