Where a person's only injuries resulting from the accident are threshold injuries, weekly benefits and treatment and care generally cease after 52 weeks (ss 3.11 and 3.28).
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).
The 2017 reforms to NSW Compulsory Third Party (CTP) motor accident compensation introduced significant changes to how claims are assessed, particularly for roundabout collisions. These reforms shifted from a strict no-fault system to a framework that considers fault, injury severity, and specific legal thresholds. On the Central Coast, these changes have altered how insurers evaluate claims, especially in scenarios where injuries may be complex or disputed. This article explains the key changes, how insurers assess liability, and what evidence is critical for successful claims.
Key Changes to CTP Claims After 2017
The 2017 reforms under the Motor Accident Injuries Act 2017 (MAIA) introduced a more nuanced approach to compensation. Previously, all drivers involved in accidents were entitled to statutory benefits regardless of fault. Now, claims depend on whether the accident involved fault, contributory fault, or injuries meeting specific thresholds. For roundabout collisions, the reforms mean insurers must assess:
- Fault determination: Whether the accident was caused by a negligent or careless driver. Roundabouts require drivers to yield, so failure to do so may establish fault.
- Threshold injuries: Injuries must meet the definition in the Motor Accident Guidelines, such as spinal nerve-root injuries or radiculopathy. Minor injuries like whiplash may not qualify unless they meet these criteria.
- Contributory fault: If the claimant contributed to the accident (e.g., by speeding or failing to yield), compensation may be reduced.
These changes mean claimants on the Central Coast must prove their injuries meet the threshold and that the accident involved fault, which is more complex than the previous system.
How Insurers Assess Liability in Roundabout Collisions
Insurers now evaluate liability based on the specific circumstances of the collision. For example:
- Driver behavior: Did the driver fail to yield to traffic on the roundabout? Did they misjudge the speed of oncoming vehicles?
- Witness statements: Eyewitness accounts are critical to establish fault, especially in collisions where vehicles are moving at similar speeds.
- Vehicle positioning: Evidence such as skid marks, damage patterns, or camera footage can determine who entered the roundabout first.
The reforms also require insurers to consider the whole person impairment of the claimant. If injuries are not threshold injuries, claimants may need to pursue a common law damages claim separately, which is not automatic under the CTP scheme.
Critical Documentation for Roundabout Claims
To support a claim, claimants must provide:
- Medical records: Detailed documentation of injuries, including imaging and specialist reports, to prove they meet the threshold injury definition.
- Accident reports: Police reports or statements from the driver’s insurance company are essential to establish fault.
- Witness details: Names and contact information for witnesses who observed the collision.
- Photographs: Images of the accident scene, vehicle damage, and road conditions.
- Income records: Proof of lost wages or reduced earning capacity, especially if the injury affects long-term work ability.
A hypothetical example illustrates this: A pedestrian injured in a roundabout collision may need to show their injury meets the spinal nerve-root criteria in the Motor Accident Guidelines. If the injury is below this threshold, they may not qualify for statutory benefits but could pursue a common law claim for damages.
Time Limits and Dispute Resolution
CTP claims must be made within 52 weeks of the accident if the only injuries are threshold injuries. After this period, statutory benefits typically stop unless the claimant can prove the injury is more severe. For non-threshold injuries, claimants may have longer timeframes but must act quickly to gather evidence.
Disputes over liability or injury severity can be resolved through the NSW Civil and Administrative Tribunal (NCAT) or the NSW Supreme Court. Claimants should seek legal advice if their claim is denied or if the insurer disputes fault.
When to Seek Legal Advice
The 2017 reforms have made CTP claims more complex, particularly for roundabout collisions where injuries may be disputed. Claimants should consult a solicitor if:
- Their injury does not meet the threshold injury definition.
- The insurer denies liability or reduces compensation due to contributory fault.
- They need to pursue a common law damages claim separately.
Legal professionals can help navigate the revised framework, ensure all evidence is properly documented, and challenge decisions that unfairly limit compensation.
Next Steps
CTP entitlements and deadlines depend on the accident date, injury type, and claim history. To request contact about your circumstances, complete the quick, no obligation enquiry form.