If a motor accident worsens a pre-existing injury, the Personal Injury Commission (PIC) must determine whether the aggravation qualifies for compensation. In Armidale, claimants must prove a direct link between the accident and the worsened condition, supported by medical evidence. This article explains how the PIC evaluates such disputes under NSW CTP rules, what evidence is required, and time limits to consider.
How the PIC Assesses Pre-existing Injury Aggravation
The PIC evaluates whether the motor accident caused a new injury or worsened an existing one. Key factors include:
- Medical evidence showing the aggravation, such as worsened symptoms or new diagnoses.
- Causation, proof the accident directly contributed to the injury's deterioration.
- Threshold injury, whether the aggravation meets the NSW Motor Accident Guidelines' criteria for a 'threshold injury' (e.g., soft tissue injuries with neurological signs).
SIRA guidelines state that claimants must demonstrate the aggravation is 'more than a temporary worsening' and that the injury meets the statutory definition of a 'personal injury' under the Motor Accident Injuries Act 2017. For example, if a pre-existing back injury worsens after a car accident, leading to chronic pain requiring ongoing treatment, the PIC will assess if the accident caused a new injury or increased the severity of the existing one.
Evidence Needed to Prove Aggravation
To support a claim, you must provide:
- Medical records detailing the pre-existing injury and its progression after the accident.
- Accident reports and witness statements to establish the incident's circumstances.
- Medical opinions from practitioners confirming the aggravation.
- Documentation of treatment (e.g., prescriptions, therapy records) showing increased need after the accident.
The PIC may request additional evidence if the link between the accident and the injury is unclear. For instance, if a claimant with a history of knee surgery experiences increased pain after a minor collision, medical evidence must show the accident caused a new injury or worsened the existing one.
Time Limits and Dispute Resolution
CTP claims must be submitted within 6 months of the accident (or 12 months if the injury was not immediately apparent). If the PIC disputes the aggravation, you may:
- Request a review through the PIC's internal process.
- Seek independent medical assessment to challenge the PIC's decision.
- Appeal to the NSW Civil and Administrative Tribunal (NCAT) if the PIC's decision is disputed.
It's important to note that the PIC may not accept claims where the aggravation is deemed 'insufficiently linked' to the accident. For example, if a pre-existing injury worsens due to unrelated factors (e.g., poor posture), the PIC may reject the claim.
Practical Example: What Happens in Disputes?
Consider a claimant with a pre-existing herniated disc who experiences increased pain and nerve damage after a car accident. The PIC may dispute the claim if:
- The medical evidence does not clearly show the accident caused the nerve damage.
- The injury does not meet the threshold injury criteria.
- The claimant fails to provide sufficient evidence of the aggravation.
In such cases, the PIC may require further medical assessments or adjust the claim's outcome based on the evidence.
When to Seek Legal Advice
If the PIC disputes your claim or you're unsure how to prove the aggravation, consult a solicitor. They can help:
- Navigate the PIC's internal review process.
- Challenge the PIC's decision with independent medical evidence.
- Appeal to NCAT if necessary.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.
When a pre-existing injury is aggravated by a motor accident, the PIC evaluates the link between the accident and the worsened condition. Medical evidence, causation, and threshold injury criteria are critical. Time limits apply, and disputes may require review or appeal. For tailored advice, complete the quick, no obligation enquiry form.