Understanding Liability in NSW CTP Claims for Pregnancy-Related Injuries
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).
Pregnancy-related injuries sustained in a motor vehicle accident in NSW are assessed under the Motor Accident Injuries Act 2017 (MAIA), which governs all Compulsory Third Party (CTP) claims. Insurers assess liability based on the legal principle of fault, not on whether the injury occurred during pregnancy. This means that if a driver was at fault for the accident, whether due to speeding, distracted driving, or failure to yield, the insurer of that driver is responsible for compensating the injured person, including for injuries that may have affected the pregnancy. This applies regardless of location within Greater Sydney, as the CTP scheme is uniform across NSW.
How Insurers Evaluate Pregnancy Injury Claims
Insurers do not treat pregnancy injuries as a separate category for liability purposes. Instead, they assess whether the injury was caused by the motor accident and whether the injured person was lawfully in the vehicle at the time of the crash. The focus is on medical causation: whether the trauma from the accident directly caused or worsened the injury to the mother or fetus. For example, if a pregnant woman suffers a placental abruption or preterm labour following a rear-end collision, the insurer will examine whether the accident was the likely cause, based on medical evidence.
Evidence That Matters in Pregnancy Injury Claims
To support a claim, the following evidence is typically required:
- A detailed medical record from a treating practitioner confirming the injury and its timing relative to the accident.
- Diagnostic imaging (such as ultrasound or MRI) showing changes in fetal condition or maternal injury.
- A report from a medical specialist, such as an obstetrician or maternal-fetal medicine specialist, linking the injury to the accident.
- Documentation of any hospital admission, emergency treatment, or changes in fetal monitoring.
Insurers may also review the accident scene, vehicle damage, and police reports to assess the severity of the impact. In Greater Sydney, where traffic density and road conditions vary, insurers may consider factors such as speed, road surface, and weather at the time of the crash.
Key Legal Considerations in NSW
Under the MAIA, a claim for injury during pregnancy is treated the same as any other personal injury claim. The insurer must determine whether the injury was caused by the accident and whether the injured person was lawfully in the vehicle. There is no automatic entitlement to compensation simply because the person was pregnant.
If the injury is classified as a threshold injury under the Motor Accident Guidelines, the claimant may only be eligible for treatment and care benefits and weekly income payments for up to 52 weeks, unless the injury is not a threshold injury. A threshold injury includes soft-tissue injuries such as whiplash, but only if they meet specific criteria, including neurological signs. A pregnancy-related injury that results in a spinal nerve-root injury with neurological signs may still qualify as a threshold injury, but only if it meets the clinical thresholds set out in the Guidelines.
Time Limits and Procedural Requirements
A claim for injury must be made within three years of the accident date, as required by the Limitation Act 1969 (NSW). However, the insurer may not process a claim until medical evidence is provided. Delays in reporting or obtaining medical assessment may affect the timing of benefit payments.
If the insurer denies liability or offers a settlement that does not fully cover the injury and associated costs, the claimant may request a review or apply to the Civil and Administrative Tribunal (NCAT) for a determination. The process for dispute resolution is available under the MAIA and is the same for all claimants, regardless of pregnancy status.
When to Seek Independent Advice
Pregnancy-related injuries can involve complex medical and legal issues, particularly when fetal health is affected. A claimant may benefit from independent legal advice if:
- The insurer disputes that the accident caused the injury.
- The injury has ongoing or long-term effects on the mother or baby.
- The claim involves a claim for damages, which requires proving a greater than 10% whole person impairment (WPI) or a non-threshold injury.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.