What the PIC Looks For in Pre-Existing Injury Aggravation Disputes
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 road accident worsens a pre-existing injury, claimants in Newcastle and Hunter must prove the aggravation meets NSW CTP scheme criteria. The Personal Injury Commission (PIC) evaluates claims by assessing whether the accident caused a new or worsened injury, not just a recurrence of an old condition. Evidence must show a clear link between the accident and the aggravation, including medical records, pre-accident assessments, and post-accident documentation.
NSW CTP Rules for Pre-Existing Injury Aggravation
Under the Motor Accident Injuries Act 2017, claimants can seek benefits for injuries aggravated by a road accident, provided the aggravation meets the 'threshold injury' definition in the Motor Accident Guidelines. This includes injuries like whiplash, back strain, or nerve damage that worsen after an accident. The PIC requires medical evidence showing the aggravation caused new symptoms or worsened existing ones beyond normal recovery.
Key legal distinctions include:
- Threshold injury: The aggravation must meet the clinical criteria in the Motor Accident Guidelines, such as spinal nerve-root injuries with neurological signs.
- Causation: The accident must be the direct cause of the aggravation, not a pre-existing condition naturally progressing.
- Statutory benefits: Weekly income payments and treatment benefits apply if the aggravation results in ongoing consequences.
Evidence and Practical Steps for Claimants
To avoid disputes, claimants should:
- Gather pre-accident medical records showing the original injury.
- Obtain post-accident medical reports linking the aggravation to the accident.
- Provide a timeline of symptoms before and after the accident.
- Include witness statements or accident reports.
A hypothetical example: A cyclist with a pre-existing knee injury experiences increased pain and instability after a collision. Medical evidence showing the accident caused new ligament damage or worsened existing instability would support a claim.
Time Limits and Dispute Resolution
Claimants must notify the PIC within 52 weeks of the accident if seeking benefits for threshold injuries. Disputes over aggravation may involve:
- Medical disputes: The PIC may request an independent medical opinion.
- Internal review: Claimants can request a review of the PIC’s decision within 28 days.
Disputes over pre-existing injuries are complex. Claimants should seek legal advice early to ensure evidence meets the PIC’s standards, especially in Newcastle and Hunter where regional practices may vary.
When to Seek Legal Advice
Disputes over aggravation often hinge on proving causation. If the PIC denies a claim, claimants may need to:
- Challenge the decision through the PIC’s internal review process.
- Pursue a legal review if the claim involves non-threshold injuries or disputes over long-term consequences.
Time limits and procedural requirements mean delays can reduce compensation options. Legal advice ensures claimants understand their rights under the NSW CTP scheme.
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