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 suffered a pregnancy-related injury in a motor vehicle accident in New South Wales, understanding how insurers assess your claim is critical. NSW CTP insurers evaluate pregnancy injuries based on the Motor Accident Injuries Act 2017 and SIRA’s general guidelines, which consider both maternal and fetal harm. This article explains how insurers determine compensation, what evidence matters, and when to seek legal advice.
How NSW CTP Insurers Assess Pregnancy-Related Injuries
NSW CTP insurers assess pregnancy injuries by evaluating whether the injury meets the 'threshold injury' criteria under the Motor Accident Injuries Act 2017. This includes injuries to the mother or fetus caused by a motor vehicle accident. SIRA’s guidelines state that injuries such as preterm labor, fetal distress, or maternal trauma may qualify, depending on medical evidence. Insurers also consider whether the injury results in long-term consequences, such as ongoing health issues for the mother or developmental delays in the child.
Factors Influencing Insurer Decisions
Insurers assess claims by reviewing medical records, accident reports, and expert opinions. Key factors include:
- Nature of the injury: Whether the injury is classified as a 'threshold injury' under SIRA’s guidelines.
- Medical evidence: Documentation from healthcare providers confirming the injury’s connection to the accident.
- Impact on daily life: How the injury affects the mother’s ability to work or care for the child.
- Fetal harm: In cases of fetal injury, evidence of developmental or health complications.
Practical Steps and Evidence to Gather
To support your claim, collect:
- Medical records detailing the injury and its link to the accident.
- Proof of pregnancy status at the time of the accident.
- Witness statements or accident reports.
- Income records if you’ve lost earnings due to the injury.
Time Limits and Dispute Options
CTP claims must be submitted within 52 weeks of the accident, unless an extension applies. If your claim is denied, you may request a review or seek mediation through SIRA. Complex cases involving pregnancy injuries may require legal advice to challenge insurer decisions.
When to Seek Independent Advice
Insurers may dispute claims involving pregnancy injuries, especially if the injury is classified as a 'threshold injury' or if there are disputes over long-term effects. A legal professional can help you understand your options and ensure your claim meets all requirements.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.