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, NSW CTP insurers must assess whether the aggravation is caused by the accident and how it affects treatment. This article explains how the Motor Accident Injuries Act 2017 handles such claims, what evidence is needed for rehabilitation planning, and practical steps for injured people in Auburn. The NSW CTP scheme covers treatment and income support for injuries caused by motor accidents, but aggravation of pre-existing conditions requires specific documentation to establish a link to the crash.
How NSW CTP Insurers Assess Aggravated Pre-existing Injuries
Under the Motor Accident Injuries Act 2017, insurers evaluate whether a motor accident caused or worsened a pre-existing condition. This involves determining if the aggravation is a direct result of the accident and whether it exceeds the original injury. For example, if a person with a pre-existing knee condition experiences increased pain or functional loss after a crash, the insurer must assess whether the accident caused this worsening.
Key factors include medical evidence showing a connection between the accident and the aggravation. SIRA guidelines emphasize that treatment planning must account for the pre-existing condition and the new injuries caused by the accident. Insurers may require detailed medical records, including pre-accident assessments and post-accident evaluations, to determine the extent of the aggravation.
Rehabilitation Documentation Required for CTP Claims
To support a CTP claim involving a pre-existing injury aggravation, injured people must provide evidence of treatment planning and rehabilitation. This includes:
- Medical records showing the pre-existing condition and its progression
- Post-accident medical reports detailing worsened symptoms
- Rehabilitation plans from healthcare providers outlining treatment goals
- Evidence of how the aggravation impacts daily activities or work capacity
Insurers may also request a rehabilitation plan from a physiotherapist or occupational therapist to demonstrate how treatment addresses both the pre-existing injury and the new aggravation. SIRA's 'What you can claim' page explains that treatment benefits cover costs like physiotherapy, medical equipment, and transportation to appointments.
Time Limits and Dispute Resolution for Aggravated Injuries
The Motor Accident Injuries Act 2017 sets time limits for claiming benefits. For example, weekly income payments and treatment benefits are generally limited to 52 weeks if only threshold injuries are involved. However, if a pre-existing injury is aggravated to the point of meeting the threshold injury definition under the Motor Accident Guidelines, benefits may continue beyond 52 weeks.
Disputes over aggravation claims often require independent medical opinions. SIRA's 'Making a motor accident claim' guide advises injured people to seek independent medical assessments if their claim is rejected. In cases where the aggravation is unclear, the insurer may refer the claim to a medical expert for review under the scheme's dispute resolution process.
Practical Example: Aggravation of a Pre-existing Back Injury
Consider a person with a pre-existing lumbar strain who experiences increased pain and reduced mobility after a car accident. Their medical records show that the pre-existing condition was managed with physical therapy but did not require significant intervention. After the accident, they develop radiculopathy (nerve-related pain) that affects their ability to work. This aggravation would qualify for CTP treatment benefits under the Act, as it meets the spinal nerve-root injury criteria in the Motor Accident Guidelines.
When to Seek Legal Advice
Injured people in Auburn should consult a legal professional if their claim is denied, if they face disputes over treatment planning, or if they need help navigating the CTP scheme. A solicitor can assist with preparing evidence, disputing insurer decisions, or negotiating a fair settlement. Time limits for claims and disputes must be carefully managed to avoid losing entitlements.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.