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).
The 2017 reforms to NSW's Compulsory Third Party (CTP) scheme introduced significant changes to how 'serious injury' is defined for compensation claims. These changes affect claimants in Bathurst and other regional areas, altering the criteria for determining eligibility for higher payouts. This article explains the legal updates, how SIRA assesses claims, and what injured persons should know about the revised threshold.
What Injuries Now Qualify as 'Serious' Under the Revised Threshold?
Under the Motor Accident Injuries Act 2017, a 'serious injury' is defined as an injury that results in a whole person impairment (WPI) of 10% or more. This replaces the previous 'threshold injury' framework, which focused on specific soft tissue injuries. The 2017 reforms expanded the scope to include injuries that may not have met the old soft-tissue criteria but still result in significant long-term impairment.
Key changes include:
- Expanded definition: Injuries such as fractures, nerve damage, or chronic pain that lead to functional limitations now qualify.
- Whole person impairment assessment: SIRA uses the Motor Accident Guidelines to calculate WPI, considering both physical and psychological impacts.
- No longer limited to soft tissue: Injuries like whiplash or spinal strain that result in ongoing disability are now eligible.
How Did the 2017 Reforms Change the Criteria for Serious Injury Claims?
The reforms shifted the focus from specific injury types to the overall impact on the injured person's life. Previously, claims for injuries like sprains or minor fractures were capped at 52 weeks of benefits. Now, the assessment centers on the severity of the injury's long-term effects.
For example, a cyclist in Bathurst who suffered a fractured wrist and chronic pain leading to reduced work capacity would now qualify for ongoing compensation, whereas this injury might have been excluded under the old rules. The reforms also clarify that injuries requiring surgical intervention or resulting in permanent disability automatically meet the threshold.
What Role Does SIRA Play in Determining Eligibility?
SIRA (State Insurance Regulatory Authority) administers the CTP scheme and assesses claims based on the Motor Accident Guidelines. They evaluate medical evidence, including:
- Detailed injury reports from medical practitioners
- Rehabilitation records
- Evidence of ongoing impairment or disability
SIRA may also consider the claimant's ability to work, daily living challenges, and psychological well-being. If a claimant disputes SIRA's assessment, they can request a review or seek independent medical opinion.
How Do These Changes Affect Claimants in Bathurst and Regional NSW?
The reforms have increased the chances of securing higher compensation for injuries that previously fell into the 'threshold injury' category. However, claimants must provide robust evidence of long-term impairment. For instance, a pedestrian in Bathurst who suffered a head injury resulting in memory loss and depression would now have a stronger case for serious injury status.
Practical steps for claimants include:
- Obtaining comprehensive medical records
- Documenting how the injury affects daily activities
- Seeking early legal advice to ensure all evidence is properly prepared
Time Limits and Dispute Options
Claimants must notify their insurer within 52 weeks of the accident. If the injury is not immediately apparent, the 52-week period starts when the injury becomes 'reasonably foreseeable.' Disputes over SIRA's assessment can be resolved through internal reviews or by lodging a complaint with the NSW Civil and Administrative Tribunal (NCAT).
When to Seek Legal Advice
The 2017 reforms have made the threshold injury assessment more complex. Injured persons in Bathurst should consult a solicitor if:
- Their injury does not fit the old soft-tissue criteria
- They are unsure whether their case meets the new WPI threshold
- They face disputes over SIRA's evaluation
Legal professionals can help navigate the process, ensure all evidence is submitted correctly, and challenge decisions that unfairly limit compensation.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.