Pre-existing Injury Aggravation in NSW CTP Claims
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 medical condition, claimants in New South Wales must prove the aggravation to access compensation. The Motor Accident Injuries Act 2017 (MAIA) governs these claims, and mistakes in documenting or communicating the injury's history can lead to denied claims. This guide explains common errors to avoid and how to build a strong case.
Key Rules Behind Pre-existing Injury Claims
Under the MAIA, CTP insurers must compensate for injuries caused or aggravated by a motor accident, regardless of pre-existing conditions. However, claimants must demonstrate that the accident worsened the injury. This requires:
- Medical evidence showing the pre-existing condition and its connection to the accident
- Proof of aggravation through clinical records, specialist reports, or expert testimony
- Timely reporting of the injury to insurers and healthcare providers
SIRA guidelines stress that insurers cannot assume a pre-existing injury is unrelated to the accident. Claimants must explicitly link the aggravation to the crash.
Practical Steps to Avoid Common Mistakes
1. Document the Pre-existing Injury
Failing to document the pre-existing condition is a frequent error. Claimants should:
- Provide medical records from before the accident
- Obtain a specialist report confirming the injury's history
- Keep records of all treatments and consultations
Without this evidence, insurers may dispute the claim, arguing the injury was unrelated to the accident.
2. Communicate with Insurers and Healthcare Providers
Delaying notification of the aggravation can harm a claim. Under the MAIA, claimants must notify insurers within 52 weeks of the accident. Delays may result in:
- Loss of weekly income benefits
- Reduced access to treatment and care benefits
Healthcare providers must also document the aggravation in medical records. Failing to mention the accident's role in worsening the injury can weaken the case.
3. Seek Early Medical Attention
Post-accident medical care is critical. Delayed treatment may make it harder to prove the aggravation. For example, if a pre-existing back injury worsens after a crash but no medical attention is sought, insurers may argue the injury was unrelated.
Time Limits and Dispute Options
The MAIA imposes strict deadlines:
- 52 weeks to notify insurers of the claim
- 52 weeks to claim weekly income benefits for threshold injuries
After this period, claimants may lose access to certain benefits. If an insurer disputes the aggravation, claimants can:
- Request a review by the insurer's internal team
- Apply for a review by the NSW Civil and Administrative Tribunal (NCAT)
Legal advice should be sought if disputes arise over the link between the accident and the aggravated injury.
Example: A Common Mistake
Consider a claimant with a pre-existing knee injury who suffers a worsened condition after a car accident. If they fail to inform their doctor about the pre-existing injury during post-accident consultations, the medical records may not show the aggravation. This omission could lead to the claim being denied, as insurers may argue the injury was unrelated to the crash.
When to Seek Legal Advice
Errors in documenting the pre-existing injury, communicating with insurers, or proving aggravation can derail a claim. Legal professionals can help by:
- Reviewing medical records for links to the accident
- Advising on compliance with time limits
- Representing claimants in disputes with insurers
Next Steps
CTP claims involving pre-existing injuries require careful documentation and timely action. To request contact about your circumstances, complete the quick, no obligation enquiry form.