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 suffered a pregnancy-related injury in a motor vehicle accident in NSW, understanding your dispute resolution options is critical. Pregnancy injuries, including maternal and fetal harm, are handled under the Motor Accident Injuries Act 2017 (MAIA) and SIRA's claims framework. This article explains how these injuries are assessed, what dispute resolution pathways exist, and how to challenge a decision.
How Pregnancy-Related Injuries Are Assessed in CTP Claims
Under NSW CTP rules, injuries must meet specific criteria to qualify for benefits. For pregnancy injuries, SIRA considers both maternal and fetal harm. Maternal injuries include physical trauma, complications like preterm labor, or emotional distress linked to the accident. Fetal injuries may involve birth defects, developmental delays, or stillbirths.
SIRA evaluates claims using the Motor Accident Guidelines, which define 'threshold injuries' as those requiring medical treatment. Pregnancy injuries are assessed based on clinical evidence, such as medical records documenting the injury's connection to the accident. If the injury is classified as a threshold injury, benefits may be limited to 52 weeks under the MAIA.
Dispute Resolution Options for Pregnancy Injury Claims
If you disagree with SIRA's decision, you have formal review pathways. First, you can request an internal review within 28 days of receiving the decision. This involves a reassessment by a senior SIRA officer.
If the review doesn't resolve the issue, you may escalate to the Personal Injury Commission (PIC), which oversees disputes about claim eligibility. The PIC can refer complex cases to the NSW Civil and Administrative Tribunal (NCAT) for mediation or formal review. In rare cases, legal action may be pursued, but this is uncommon and requires strong evidence.
Key Evidence and Practical Steps
To support a pregnancy injury claim, gather: medical records confirming the injury's link to the accident, documentation of treatment costs, and evidence of how the injury impacted your health or pregnancy. Witness statements or accident reports may also be relevant.
If a dispute arises, ensure all correspondence with SIRA is documented. Keep copies of all medical reports and communications. If the injury involves fetal harm, obtain specialist opinions from obstetricians or fetal medicine experts.
Time Limits and When to Seek Advice
You must notify SIRA of your claim within 52 weeks of the accident. If you're disputing a decision, act quickly: internal reviews must be requested within 28 days. Delays can jeopardize your ability to challenge a decision.
Example: A Pregnancy Injury Claim in Dispute
Consider a scenario where a pregnant woman sustains a soft tissue injury in a collision. SIRA may classify the injury as a threshold injury, limiting benefits to 52 weeks. If the claimant argues the injury caused preterm labor requiring hospitalization, they must provide medical evidence linking the accident to the pregnancy complications.
Next Steps
CTP claims involving pregnancy injuries require careful navigation of SIRA's guidelines and dispute processes. While the MAIA provides a framework, pregnancy-related claims often involve complex medical and legal considerations. To discuss your circumstances, complete the quick, no obligation enquiry form.