Pregnancy-related injuries in NSW CTP claims: What the PIC expects in disputes
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 been injured in a car accident while pregnant, understanding how the Personal Injury Claimant (PIC) assesses your claim is critical. Under New South Wales law, pregnancy-related injuries are treated as serious road trauma claims, with specific rules about medical evidence, compensation thresholds and dispute resolution. This article explains what the PIC expects when disputes arise over pregnancy injuries in CTP motor accident claims.
What medical evidence is required for pregnancy injury claims?
To support a pregnancy injury claim under NSW CTP laws, you must provide medical evidence showing a direct link between the accident and your injury. This includes:
- A medical report confirming pregnancy-related harm (e.g. placental abruption, preterm labour, fetal injury)
- Documentation of medical treatment received
- Evidence of how the injury has impacted your health or ability to work
SIRA guidelines require medical professionals to use the Motor Accident Guidelines to assess whether the injury meets the 'threshold injury' definition. For example, a pregnant woman who experiences a miscarriage due to a road accident must provide medical records showing the causal connection between the accident and the pregnancy loss.
How does SIRA determine compensation for pregnancy-related injuries?
SIRA evaluates pregnancy injuries using the same framework as other motor accident claims. The PIC will consider:
- The severity of the injury (e.g. whether it's a 'threshold injury' under s 3.28 of the Motor Accident Injuries Act 2017)
- The impact on your health and daily life
- The cost of medical treatment and care
In disputes, SIRA may request additional medical reports or consult with specialists. For example, if a claimant alleges fetal harm, the PIC may require an obstetrician's report confirming the injury's connection to the accident. The compensation amount depends on the injury's nature and the evidence provided.
What are the PIC's obligations when disputes arise?
When disputes occur over pregnancy injury claims, the PIC must follow specific procedures:
- Internal review: The PIC must first review the claim internally before referring it to SIRA. This process typically takes 21 days from the date of the request.
- Medical dispute pathway: If there's disagreement about the injury's severity, the PIC must refer the matter to the Personal Injury Commission for medical assessment. This process can take up to 90 days.
- Evidence review: The PIC must consider all available medical evidence, including independent reports, before making a compensation decision.
It's important to note that a challenge does not guarantee a changed decision. The PIC must be satisfied that the original assessment was incorrect. For example, if a claimant disputes the PIC's decision that a pregnancy-related injury does not meet the threshold, they must provide new evidence showing the injury meets the legal definition.
Practical steps for pregnancy injury claims
To strengthen your claim, take these steps:
- Seek immediate medical attention after the accident
- Document all medical treatments and expenses
- Keep records of how the injury has affected your work or daily activities
- Report the accident to the at-fault driver's insurance company
If you're unsure whether your injury meets the threshold, contact SIRA for guidance. The PIC may also request a medical assessment to determine the injury's severity.
Time limits and when to seek advice
You have 3 years from the date of the accident to make a CTP claim under NSW law. However, time limits for medical treatment and evidence collection may be shorter. If you're facing a dispute over your pregnancy injury, seek legal advice promptly. A solicitor can help you:
- Gather necessary medical evidence
- Challenge the PIC's decision if you believe it's incorrect
- Navigate the SIRA dispute resolution process
What happens if the PIC disputes your claim?
If the PIC disputes your pregnancy injury claim, they must follow the formal dispute process. This includes:
- Requesting additional medical evidence
- Referring the matter to the Personal Injury Commission for medical assessment
- Making a final decision based on all available evidence
You have the right to request a review of the PIC's decision. However, the PIC is not required to change their decision unless new evidence shows an error in the original assessment.
When to seek independent legal advice
If you're unsure whether your pregnancy-related injury meets the threshold for compensation, or if you're facing a dispute over your claim, seek legal advice. A solicitor can:
- Help you understand your rights under NSW CTP laws
- Assist with gathering and presenting medical evidence
- Represent you in disputes with the PIC or SIRA
Remember, every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.