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 pregnancy-related injury in a car accident in NSW, understanding how insurers assess claims is critical. Under the Motor Accident Injuries Act 2017 (MAIA), insurers must evaluate claims based on medical evidence, SIRA guidelines, and the nature of the injury. This article explains how insurers determine compensation for maternal and fetal injuries, the factors they consider, and steps to improve your claim outcome.
How Insurers Assess Pregnancy-Related Claims
Insurers evaluate claims by examining medical records to confirm pregnancy-related injuries, such as fetal harm, maternal trauma, or complications like preterm labour. Under SIRA guidelines, injuries must meet the 'threshold injury' criteria outlined in the Motor Accident Guidelines. For example, a spinal nerve-root injury causing neurological signs may qualify as a soft-tissue injury, even if radiculopathy isn't present.
Insurers also assess whether the injury resulted directly from the accident. Fetal injuries, such as brain damage or limb abnormalities, require clear medical evidence linking the accident to the harm. Maternal injuries, like internal bleeding or organ damage, must be documented with diagnostic imaging or specialist reports.
Key Factors in Insurer Decisions
- Medical Evidence: Detailed records from obstetricians, radiologists, and maternal-fetal medicine specialists are essential. Insurers may request additional tests to confirm injury severity.
- SIRA Guidelines: These outline what injuries qualify for statutory benefits. For instance, a fractured pelvis or uterine rupture would typically meet the threshold, while minor bruising might not.
- Fetal Viability: If the injury results in a non-viable pregnancy or severe fetal harm, insurers may consider this a 'major injury' under the MAIA.
- Timing of Injury: Claims must be made within 52 weeks of the accident for certain benefits. After this period, insurers may limit weekly payments unless the injury is classified as a 'major injury' under the Act.
Practical Steps for Claimants
- Secure Immediate Medical Attention: Document all treatments, including ultrasounds, blood tests, and specialist consultations.
- Preserve Accident Evidence: Keep police reports, witness statements, and photos of the scene. If the accident occurred in a car park or on private property, note the location and vehicle use.
- Request SIRA’s Injury Assessment: You can apply for a free assessment to determine if your injury meets the threshold. This helps insurers evaluate claims consistently.
Disputes and When to Seek Advice
If an insurer denies your claim, review their decision using the SIRA guidelines. Disputes often arise over whether the injury qualifies as a 'threshold injury' or if the claim falls outside the 52-week window. Legal advice is recommended if the insurer refuses to consider fetal injuries or disputes the severity of maternal harm.
Example Scenario
Consider a case where a pregnant woman collides with a car, resulting in a fractured pelvis and fetal brain injury. Medical records confirm the maternal injury meets the threshold, and the fetal harm is documented via MRI scans. Under SIRA guidelines, the claimant would be entitled to weekly payments and treatment benefits, with the insurer required to assess the claim within 52 weeks.
Next Steps
Time limits and procedural requirements vary depending on the accident date and injury type. To request contact about your circumstances, complete the quick, no obligation enquiry form.