If you've suffered a psychological injury in a car accident in Bega, NSW, and are facing a dispute over your CTP claim, understanding your options is critical. Under the Motor Accident Injuries Act 2017 (MAIA), psychological injuries like PTSD, anxiety, or depression may qualify as 'threshold injuries' if they meet specific clinical criteria. This article explains how to challenge SIRA decisions, what evidence is required, and the legal steps available to resolve disputes.
What is a Threshold Injury for CTP Claims?
A threshold injury under the MAIA includes soft tissue injuries and psychological injuries that are not classified as recognised psychiatric illnesses. For example, adjustment disorder or acute stress disorder may qualify, but conditions like bipolar disorder or schizophrenia typically do not. The Motor Accident Guidelines (MAG) provide detailed criteria for assessing whether a psychological injury meets the threshold definition.
How to Challenge a SIRA Decision
If SIRA denies your claim, you have two main options: internal review or external review by the Personal Injury Commission (PIC). Both require specific evidence:
- Internal review: Submit fresh medical evidence, such as updated psychological reports, to the Claims Resolution Panel. This process allows SIRA to reassess the claim using the same guidelines.
- External review: Apply to the PIC, which may order an independent psychiatric assessment. The PIC has the authority to overturn SIRA's decision if it finds an error in applying the law.
Evidence Required for Psychological Injuries
SIRA evaluates claims based on clinical evidence. Key documentation includes:
- Detailed medical records linking the injury to the accident.
- Diagnosis codes (e.g., ICD-10 codes for PTSD).
- Records of therapy sessions, medication, and treatment progress.
- Evidence of how the injury affects daily life, such as work absences or relationship strain.
Time Limits for Dispute Resolution
Strict deadlines apply:
- Internal reviews must be requested within 28 days of the initial decision.
- PIC applications must be submitted within 28 days of the internal review outcome.
- Court claims must be initiated within 6 years of the accident (Civil Procedure Act 2005 s 128). Delays beyond these limits may result in losing the right to challenge a decision.
Practical Steps for Injured Parties
To resolve disputes effectively:
- Gather comprehensive medical evidence showing a clear link between the accident and your psychological injury.
- Preserve accident-related evidence like police reports, witness statements, and photographs.
- Follow SIRA's procedures for internal reviews and PIC applications.
- Seek legal advice early to challenge SIRA's interpretation of medical evidence or navigate court procedures.
When to Seek Legal Advice
Disputes over psychological injuries are complex. A solicitor can:
- Challenge SIRA's interpretation of medical reports.
- Help navigate PIC or court processes.
- Assist with negotiations with insurers.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.