Pregnancy Injuries in NSW CTP Claims: What SIRA Looks For 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 during pregnancy and are dealing with a dispute over your compensation, it's important to understand what the Personal Injury Commission (PIC) expects. In New South Wales, the assessment of pregnancy-related injuries in motor accidents is governed by the Motor Accident Injuries Act 2017 (MAIA) and the guidelines issued by the State Insurance Regulatory Authority (SIRA). This article explains what SIRA typically considers when evaluating disputes involving pregnancy injuries, including the medical evidence required, impairment thresholds, and the dispute resolution process.
What SIRA Considers in Pregnancy Injury Disputes
When assessing a claim for pregnancy-related injuries, SIRA evaluates several key factors. First, they look at the medical evidence to determine whether the injury has caused a measurable impairment. This includes clinical assessments, imaging reports, and specialist opinions. Pregnancy-related injuries may include complications such as preterm labour, placental abruption, or fetal distress, all of which require detailed medical documentation.
SIRA also considers the impact of the injury on the mother’s health and the well-being of the fetus. For example, if the injury has led to a significant reduction in the mother’s ability to perform daily activities or has caused long-term health issues, this may affect the level of compensation. Additionally, the PIC will assess whether the injury meets the threshold for a claim under the MAIA, which typically requires a whole person impairment rating of 10% or more.
How Pregnancy Injuries Are Assessed for Compensation
Under NSW CTP laws, pregnancy injuries are assessed based on the same principles as other injuries. This means that the injury must be directly related to the motor accident and not a pre-existing condition. SIRA will also consider whether the injury has resulted in a loss of income, increased medical expenses, or a need for ongoing care.
If the injury is classified as a 'threshold injury', meaning it has caused a measurable impairment, the claimant may be eligible for weekly income payments and treatment and care benefits. However, if the injury is not above the threshold, the claimant may not be entitled to ongoing benefits after 52 weeks. This distinction is important in disputes, as it affects the type and duration of compensation available.
Dispute Resolution Options for Pregnancy Injury Claims
If you believe your claim has been denied or undervalued, there are several options for dispute resolution. One option is to request a review of the decision by the PIC. This involves submitting new evidence or a challenge to the existing assessment. Another option is to seek independent medical advice to support your case.
If the dispute escalates, you may need to consider mediation or formal review processes. It’s important to note that a challenge does not guarantee a changed decision. SIRA will assess all new evidence carefully and may uphold the original decision if they believe the evidence does not support a change.
Practical Steps and Evidence That Usually Matter
To support your claim, it’s essential to gather and preserve all relevant evidence. This includes medical records, accident reports, witness statements, and any correspondence with the insurer. You should also keep records of any income loss or additional expenses related to the injury.
If you’re experiencing complications during pregnancy as a result of the accident, it’s important to seek medical attention immediately. Your healthcare provider can provide documentation that supports your claim and helps establish the link between the accident and your injury.
When to Seek Legal Advice
If you’re unsure about the outcome of your claim or if you believe the PIC has made an error in their assessment, it may be beneficial to seek legal advice. A solicitor can help you understand your options, challenge the decision, or assist with the dispute resolution process.
Time Limits and Procedural Requirements
It’s important to be aware of the time limits for making a claim under NSW CTP laws. Generally, you must notify the PIC of your claim within a certain timeframe, although this can vary depending on the circumstances of the accident. If you’re unsure about the deadlines, it’s best to seek advice as soon as possible.
Conclusion
Pregnancy injuries in motor accidents are assessed under the same principles as other injuries in NSW CTP claims. SIRA evaluates the medical evidence, impairment rating, and the impact of the injury on the claimant’s life. If you’re involved in a dispute, it’s important to understand what the PIC expects and to gather all relevant evidence to support your case. Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.