If you've suffered a pregnancy-related injury in a car accident in New South Wales, understanding how insurers assess your claim is critical. NSW Compulsory Third Party (CTP) insurers must evaluate whether your injury meets the legal threshold for compensation under the Motor Accident Injuries Act 2017. This article explains how insurers assess pregnancy injuries, the evidence they require, and how to challenge unfair decisions.
How NSW CTP insurers assess pregnancy injury claims
NSW CTP insurers assess pregnancy-related injuries using the Motor Accident Guidelines and the Spinal Injury Assessment Tool. These tools define what constitutes a 'threshold injury' under the scheme. For pregnancy injuries, insurers focus on whether the injury caused maternal harm or fetal injury that meets the statutory definition of a 'personal injury'.
Insurers typically require medical evidence to prove:
- A direct link between the accident and the injury
- That the injury caused physical or psychological harm to the mother or fetus
- That the injury meets the threshold injury criteria (e.g., soft tissue injury with neurological signs)
For example, if a car accident caused a ruptured amniotic sac or premature labor, insurers will assess whether this meets the injury threshold. They may also consider fetal distress or birth complications as part of the claim.
SIRA guidelines for pregnancy injury claims
The State Insurance Regulatory Authority (SIRA) provides the official framework for assessing pregnancy injuries. Under the Motor Accident Claims page on SIRA’s website, pregnancy injuries are treated as personal injuries if they result in:
- Maternal hospitalization
- Fetal injury requiring medical intervention
- Long-term health complications for the mother or child
SIRA’s What You Can Claim page clarifies that pregnancy injuries are eligible for treatment and care benefits, weekly income payments, and damages if they meet the injury threshold. However, insurers may dispute claims if the injury is deemed minor or not directly caused by the accident.
Proving causation for pregnancy injuries
One of the biggest challenges in pregnancy injury claims is proving causation. Insurers will scrutinize:
- Medical records showing the injury occurred during or shortly after the accident
- Doctor’s reports linking the injury to the accident
- Witness statements or accident reports confirming the incident
For instance, if a pregnant woman experienced a ruptured uterus after a collision, the insurer must be shown that the injury was caused by the accident, not pre-existing conditions. Medical experts may need to testify about the causal link.
Challenging unfair insurer decisions
If an insurer denies your pregnancy injury claim, you can challenge the decision by:
- Requesting a review under the Motor Accident Injuries Act 2017
- Providing additional evidence (e.g., new medical reports or expert opinions)
- Seeking independent legal advice to contest the decision
Insurers must provide a written explanation for their decision, including the reasons for denying the claim. If they fail to follow the correct process, you may have grounds to appeal.
Time limits and next steps
NSW CTP claims must be made within five years of the accident. However, medical evidence must be submitted within five years of the injury being discovered. If you’re unsure whether your claim is time-barred, contact a legal professional immediately.
When to seek legal help
Pregnancy injury claims often require specialized legal advice due to the complex medical and legal issues involved. A solicitor can help you:
- Navigate the SIRA claims process
- Challenge unfair decisions by insurers
- Ensure you receive all entitled benefits under the CTP scheme
If you’re in Armidale or elsewhere in NSW, contact a local solicitor or use the quick, no obligation enquiry form to request assistance.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.