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).
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 motor accident worsens a pre-existing injury, determining compensation depends on how SIRA evaluates the aggravation. This article explains the legal rules, SIRA’s assessment process, and practical steps for claimants in the Blue Mountains and Nepean regions.
How SIRA assesses pre-existing injury aggravation
Under the Motor Accident Injuries Act 2017, SIRA must determine whether a motor accident caused a new or worsened injury. For pre-existing injuries, SIRA considers:
- Medical evidence showing the injury worsened after the accident
- The accident’s nature and severity
- Whether the aggravation is a direct result of the accident
SIRA uses the Motor Accident Guidelines to assess whether the aggravation meets the 'threshold injury' definition. For example, if a person with a pre-existing back condition experiences increased pain or functional loss after a crash, SIRA will evaluate medical records to confirm the worsening.
Key factors in SIRA’s regional guidelines
In the Blue Mountains and Nepean, SIRA applies the same legal principles as elsewhere but may have local considerations, such as:
- Access to specialist medical opinions
- Regional healthcare provider availability
- Unique accident scenarios (e.g., rural road conditions)
Claimants should ensure medical records clearly link the accident to the aggravation. SIRA may request additional evidence, such as witness statements or accident reports, to establish this connection.
Practical steps for claimants
- Document the pre-existing injury: Provide medical records, treatment history, and a doctor’s statement confirming the injury existed before the accident.
- Record the accident details: Include dates, locations, and any witness information. For example, a collision on a Nepean highway may involve specific road conditions.
- Seek specialist medical opinion: A doctor should confirm that the accident caused a new or worsened injury. This is critical for SIRA to assess whether the aggravation meets the threshold.
- Submit claims promptly: While there is no fixed deadline for aggravation claims, delays may affect SIRA’s ability to review evidence.
Time limits and dispute resolution
Statutory benefits for threshold injuries are generally limited to 52 weeks under s 4.4 of the Motor Accident Injuries Act 2017. If a claim involves both pre-existing injuries and new injuries, SIRA will assess them separately. Disputes over aggravation may require a review by SIRA’s internal process or a court application.
Example: Aggravation of a pre-existing knee injury
A person with a pre-existing knee condition (e.g., meniscus tear) sustains a motor accident that causes increased pain and reduced mobility. SIRA will evaluate:
- Medical records showing pre-existing knee issues
- Post-accident imaging or reports indicating worsened condition
- Whether the accident caused the aggravation
If SIRA finds the aggravation meets the threshold, the claimant may receive treatment and income benefits for the worsened injury.
When to seek legal advice
SIRA’s decisions are final unless challenged through a court application. If you believe SIRA has misinterpreted your claim, consult a solicitor to explore options such as:
- Applying for a review under s 33 of the Motor Accident Injuries Act 2017
- Filing a court action for damages
Next steps
CTP entitlements depend on the accident date, injury type, and claim history. To discuss your circumstances, complete the quick, no obligation enquiry form.