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 you've suffered a motor accident that worsened a pre-existing injury, you may be eligible for compensation under NSW's Compulsory Third Party (CTP) scheme. However, claimants in Illawarra and South Coast must avoid common pitfalls to ensure their claim is processed fairly. This guide explains how to navigate CTP claims involving pre-existing injuries, based on SIRA guidelines and regional practices.
Understanding Pre-existing Injury Aggravation in CTP Claims
Under the Motor Accident Injuries Act 2017, a claimant must prove that the accident caused or worsened their injury. For pre-existing injuries, this requires medical evidence showing a direct link between the crash and the aggravation. SIRA guidelines stress that insurers will scrutinise claims where an injury predates the accident.
Common mistakes include failing to document the pre-existing condition adequately. Claimants should keep records of all prior medical treatments, including dates, diagnoses, and treatment plans. Without this evidence, insurers may dispute the claim, arguing the injury was not caused by the accident.
Key SIRA Guidelines for Pre-existing Injury Claims
SIRA's What you can claim page clarifies that compensation may cover:
- Medical treatment for the aggravated injury
- Lost income due to the worsened condition
- Pain and suffering from the aggravation
However, claimants must demonstrate that the accident caused a "material worsening" of the injury. This often requires a medical report from a specialist confirming the aggravation. In Illawarra and South Coast, some claimants have lost benefits because they failed to obtain such reports.
Practical Steps to Avoid Claim Disputes
- Secure medical documentation: Obtain a report from a doctor or physiotherapist linking the accident to the worsened injury. This should include pre-accident condition records and post-accident assessments.
- Notify your insurer promptly: Delays in reporting can lead to disputes. SIRA advises claimants to notify their insurer within 28 days of the accident, though this deadline may vary for complex cases.
- Avoid altering medical records: Insurers may challenge claims if they suspect the injury was not aggravated by the accident. Ensure all records are accurate and unaltered.
Time Limits and Dispute Resolution
CTP claims must be submitted within 52 weeks of the accident for certain benefits, though this period may extend for complex cases. Claimants should act quickly to avoid missing statutory deadlines. If disputes arise, SIRA's dispute resolution process allows for independent assessments by medical experts.
When to Seek Legal Advice
In Illawarra and South Coast, some claimants have faced setbacks due to misunderstandings about their rights. For example, one case involved a cyclist whose pre-existing knee injury worsened after a crash. The claimant lost benefits because they did not obtain a specialist report confirming the aggravation. Legal advice can help ensure all evidence is properly prepared.
Final Steps for Claimants
If you're navigating a CTP claim involving a pre-existing injury, take these steps:
- Gather all medical records related to the injury
- Consult a medical professional to assess the aggravation
- Submit your claim to the insurer within the required timeframe
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.