How SIRA determines if a motor accident aggravates a pre-existing injury
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 you’ve had a pre-existing injury worsened by a motor accident, the New South Wales Compensation and Injury Claims (CIC) scheme determines whether you’re entitled to benefits. The key question is: did the accident cause a material worsening of your condition? The State Insurance Regulatory Authority (SIRA) provides specific guidelines to assess this.
What SIRA considers a pre-existing injury aggravation
SIRA defines aggravation as a material worsening of a pre-existing injury caused by a motor accident. This means the accident must have made your injury:
- More severe than it would have been without the accident
- Resulted in additional pain, disability or treatment
- Led to a new or worsened condition
For example, if you had a pre-existing back injury and the accident caused a herniated disc that required surgery, this could qualify as aggravation. However, if your existing condition simply flared up without new damage, it may not meet the threshold.
Proving injury aggravation under NSW CTP laws
To claim benefits for an aggravated injury, you must provide:
- Medical evidence showing the pre-existing injury and its worsening
- Accident details proving the incident caused the aggravation
- Expert opinion from a medical practitioner confirming the link
SIRA requires a clear connection between the accident and the worsened condition. This often involves:
- Medical records showing pre-existing injury and post-accident deterioration
- Statements from treating doctors explaining the aggravation
- Evidence of increased treatment needs or functional loss
Time limits and dispute resolution
Claims must be made within 52 weeks of the accident under the Motor Accident Injuries Act 2017. If your injury is not aggravated, benefits stop after this period. However, if the aggravation is confirmed later, you may still be eligible for additional payments.
If you disagree with SIRA’s assessment, you can request a review. Complex cases may require a medical expert to re-examine the evidence.
When to seek legal advice
Contact a solicitor if:
- Your injury involves multiple pre-existing conditions
- You’re unsure if your case meets the aggravation threshold
- You need help gathering medical evidence
Independent legal advice ensures you understand your rights under the NSW CTP scheme.
Next steps
CTP claims involving pre-existing injuries depend on proving a direct link between the accident and worsened condition. To request contact about your circumstances, complete the quick, no obligation enquiry form.