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, you may be eligible for compensation under NSW's Compulsory Third Party (CTP) scheme. However, time limits and specific requirements apply, especially in rural and remote areas. This article explains how NSW law handles such claims, focusing on critical deadlines, SIRA's approach to pre-existing injuries, and evidence needed to support your case.
Time Limits for Pre-existing Injury Aggravation Claims
Under NSW law, claims for aggravated pre-existing injuries must be made within 52 weeks of the accident. This applies to 'threshold injuries', injuries that meet specific medical criteria outlined in the Motor Accident Guidelines. If your injury is aggravated beyond the threshold, you may be eligible for additional compensation, but time limits still apply.
The 52-week period is statutory, meaning it cannot be extended unless there are exceptional circumstances. For example, if you were unable to seek medical attention immediately due to remote location access issues, you may need to provide evidence to support a reasonable delay. SIRA's guidelines emphasize that claims must be submitted promptly, with documentation showing the aggravation occurred within the 52-week window.
SIRA's Approach to Pre-existing Injuries in Rural NSW
SIRA (State Insurance Regulatory Authority) handles CTP claims in NSW, including those involving pre-existing injuries. In rural and remote areas, SIRA may apply slightly different procedural rules due to challenges like limited access to medical services or longer travel times for assessments. For instance, claims involving complex medical evidence may require additional time for review, but this does not extend the 52-week deadline.
SIRA's guidelines stress that claims must demonstrate a clear link between the accident and the aggravation of the pre-existing injury. This requires medical evidence showing that the injury worsened as a result of the accident, not due to natural progression or other factors. In rural areas, this may involve coordinating with local healthcare providers to ensure records are complete and meet SIRA's standards.
Evidence Required for Aggravation Claims
To prove that a pre-existing injury was aggravated by a motor accident, you must provide:
- Medical records showing the original injury and its condition before the accident
- Evidence of the accident, such as police reports, witness statements, or photographs
- Post-accident medical records demonstrating worsened symptoms or new complications
- A medical opinion linking the aggravation to the accident
In rural NSW, obtaining and submitting this evidence may take longer due to logistical challenges. SIRA encourages claimants to communicate regularly with their case manager to ensure all documentation is submitted on time.
Example: Aggravated Pre-existing Injury in a Rural Context
Consider a scenario where a person with a pre-existing knee condition (not meeting threshold injury criteria) experiences a motor accident that causes significant swelling and instability. If medical records show the injury worsened after the accident and the claim is submitted within 52 weeks, SIRA may assess it as a new injury eligible for compensation. However, if the claim is delayed beyond 52 weeks, it may be denied unless exceptional circumstances are proven.
When to Seek Legal Advice
If you're unsure whether your claim falls within the 52-week limit or need help gathering evidence, seek legal advice promptly. Rural claimants may face additional hurdles, such as coordinating with distant medical professionals or navigating SIRA's remote claims process. Legal professionals can help ensure your claim meets all requirements and is submitted before deadlines.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.