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 you've suffered a new motor accident that worsens a pre-existing injury, understanding how SIRA assesses your claim is critical. In New South Wales, claims where an existing medical condition is aggravated by a new accident require careful documentation of treatment and rehabilitation planning. This article explains how SIRA evaluates such cases, what evidence matters in Albury, and how to avoid disputes over pre-existing injuries.
How SIRA Assesses Pre-existing Injury Aggravation
SIRA evaluates whether a new motor accident has worsened a pre-existing injury by considering medical evidence and the nature of the aggravation. Under the Motor Accident Injuries Act 2017, a claimant must prove that the new accident caused a 'threshold injury', defined as an injury that meets specific clinical criteria, such as a spinal nerve-root injury with neurological signs. For example, if you had a pre-existing back injury and a car accident caused new disc damage leading to nerve pain, SIRA would assess whether this meets the threshold injury definition.
Key factors include:
- Medical records showing the pre-existing condition and its progression
- Evidence linking the new accident to the aggravation
- Rehabilitation plans that address both the original injury and the new complications
Practical Steps for Treatment and Rehabilitation Planning
In Albury, claimants must document their treatment and rehabilitation plans to demonstrate how the new injury impacts their recovery. This includes:
- Obtaining a detailed medical report from your treating doctor explaining the pre-existing injury and how the new accident worsened it
- Providing evidence of treatment plans, such as physiotherapy sessions or specialist consultations
- Keeping records of any changes in your condition, such as increased pain or mobility issues
SIRA requires claimants to submit a 'rehabilitation plan' outlining how treatment will address both the pre-existing injury and the new aggravation. This plan must be supported by medical professionals and show a clear link between the new accident and the worsened condition.
Time Limits and Dispute Avoidance
Claims must be submitted within 52 weeks of the accident if the only injuries are threshold injuries. However, if the aggravation results in a whole person impairment (WPI) of 10% or more, the 52-week limit does not apply. In Albury, claimants should seek legal advice promptly to ensure they meet deadlines and avoid disputes over the nature of their injuries.
Common disputes arise when claimants fail to provide sufficient evidence of the aggravation. For example, if a pre-existing knee injury is worsened by a car accident but the medical records do not clearly show the link, SIRA may dispute the claim. Proper documentation is essential to avoid such issues.
Example: Aggravated Pre-existing Injury in Albury
Consider a claimant with a pre-existing knee ligament injury who suffers a car accident causing a meniscus tear. The treating surgeon must document how the new tear worsened the existing instability and how rehabilitation plans address both injuries. Without this evidence, SIRA may not accept the claim as a threshold injury.
When to Seek Legal Advice
In regional areas like Albury, claimants may face challenges accessing legal resources. It is advisable to consult a solicitor early to ensure all evidence is properly prepared and that the claim meets SIRA's requirements. Legal advice can also help navigate disputes over the nature of the aggravation and ensure compliance with time limits.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.