How SIRA assesses pre-existing injury aggravation in 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).
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 medical condition, injured people in New South Wales may be eligible for compensation under the Compulsory Third Party (CTP) scheme. The New South Wales Motor Accident Injuries Act 2017 and SIRA’s guidelines define how claims for aggravated pre-existing injuries are evaluated. This article explains how SIRA handles such claims on the Central Coast, what evidence is needed, and when to seek legal advice.
Legal framework for pre-existing injury aggravation
Under NSW CTP laws, a claimant must prove that the motor accident caused a new injury or worsened an existing condition. SIRA’s guidelines clarify that aggravation of a pre-existing injury is treated as a new injury for compensation purposes. This applies even if the original condition was not caused by the accident. The key is demonstrating a direct link between the accident and the worsened condition.
SIRA’s Central Coast guidance emphasizes that claimants must provide medical evidence showing:
- A documented history of the pre-existing injury
- A clear connection between the accident and the aggravation
- That the aggravation caused additional harm (e.g., increased pain, reduced mobility)
This approach aligns with the Motor Accident Injuries Act 2017, which requires claims to show a 'threshold injury', a defined level of harm that qualifies for compensation. Aggravation claims must meet this threshold to be eligible for benefits.
Evidence needed to prove aggravation
To support a claim for aggravated pre-existing injury, claimants should gather:
- Medical records showing the original injury and its progression
- Doctor’s reports linking the accident to worsened symptoms
- Accident details (e.g., date, location, vehicle involved)
- Witness statements or photographs of the incident
- Income records if the injury affects earning capacity
SIRA’s Central Coast team has clarified that claims must show the aggravation caused 'new consequences' beyond the original injury. For example, if a pre-existing back injury worsened to the point of requiring surgery after an accident, this would qualify as a new injury under the scheme.
Time limits and dispute resolution
CTP claims must be made within 52 weeks of the accident, unless an extension applies. For aggravation claims, the 52-week limit starts from the date of the accident, not the date of the worsened condition. If the aggravation occurs after this period, claimants may need to pursue a separate legal action.
Disputes over aggravation claims are resolved by SIRA’s independent assessors. Claimants should request a review if their claim is rejected, providing additional medical evidence or clarification. It’s important to note that SIRA’s Central Coast office has specific procedures for assessing such claims, which may differ slightly from other regions.
When to seek legal advice
Claimants should consult a solicitor if:
- Their aggravation claim is denied
- They need help gathering medical evidence
- They’re unsure if their injury meets the threshold for compensation
- They face disputes with insurers
Legal professionals can help navigate SIRA’s assessment process and ensure all requirements are met. This is particularly important for Central Coast claimants, as location-specific factors may influence the evaluation.
Next steps for Central Coast claimants
If you believe a motor accident has worsened a pre-existing injury, start by documenting all medical evidence and accident details. Contact SIRA’s Central Coast office to discuss your claim, and consider seeking legal advice if your case is rejected. Every claim depends on its own facts, for tailored guidance, complete the quick, no obligation enquiry form.