What SIRA considers a 'serious injury' under NSW CTP laws
A 'serious injury' under the Motor Accident Injuries Act 2017 is not defined by severity alone, but by specific medical and functional criteria. SIRA confirms that a serious injury is one that results in a permanent impairment of at least 15% of the whole person, or a permanent loss of function that significantly affects daily life. This includes injuries such as permanent brain injury, spinal cord injury, or major limb loss. The injury must be caused by a motor vehicle accident and must be assessed by a qualified medical practitioner using the Australian Institute of Health and Welfare (AIHW) Whole Person Impairment (WPI) assessment method.
SIRA’s interpretation is guided by the Motor Accident Injuries Regulation 2017 and the Motor Accident Injuries Guidelines. These documents clarify that not all long-term injuries qualify as serious. For example, a back injury that causes ongoing pain but does not result in a measurable impairment of 15% or more will not meet the threshold. The assessment must be based on objective clinical evidence, not subjective symptoms alone.
How SIRA's definition affects compensation eligibility
Meeting the serious injury threshold under SIRA’s framework opens access to a broader range of benefits under the CTP scheme. Unlike claims based on minor or threshold injuries, a serious injury allows for claims for damages in addition to statutory benefits. This includes compensation for pain and suffering, loss of enjoyment of life, and future care and support needs.
The Motor Accident Injuries Act 2017, section 4.4, limits damages for claims where the only injuries are threshold injuries. However, if a claimant meets the serious injury threshold, this restriction does not apply. This means that even if a claimant has a pre-existing condition, they may still be eligible for damages if the accident caused a significant and permanent worsening of their condition.
SIRA also notes that a claim may still be considered serious even if the injury does not result in a 15% WPI if it causes a permanent loss of function that prevents the person from performing essential daily tasks, such as walking, dressing, or working. The determination is made on a case-by-case basis, based on medical evidence and functional impact.
What medical evidence is required to meet the serious injury threshold
To establish a serious injury, claimants must provide objective medical evidence that demonstrates both the nature of the injury and its lasting impact. SIRA requires a formal Whole Person Impairment (WPI) assessment conducted by a qualified medical practitioner, such as a specialist in rehabilitation medicine, neurology, or orthopaedics. The assessment must be performed at least 12 months after the accident to ensure stability of the condition.
Key evidence includes:
- A detailed medical report outlining the diagnosis, treatment history, and current functional capacity.
- Imaging results such as MRI or CT scans showing structural damage.
- Neurological or psychological assessments where applicable, particularly for brain or spinal injuries.
- Evidence of permanent loss of function, such as inability to walk, use a limb, or perform basic self-care tasks.
- A functional capacity assessment showing the individual’s ability to perform daily activities compared to pre-accident levels.
SIRA emphasises that subjective reports of pain or discomfort, while important, are not sufficient on their own. The assessment must demonstrate a permanent and measurable impact on the person’s ability to live independently or work.
Practical steps and evidence that usually matter
If you believe you may have sustained a serious injury, the first step is to seek medical treatment and ensure all records are preserved. This includes all medical reports, imaging, and treatment notes from the time of the accident to the present. These documents form the foundation of any claim.
You should also preserve any evidence related to the accident, including:
- Photographs of the scene, vehicle damage, or injuries.
- Witness statements, particularly if they observed the impact or your condition immediately after.
- Accident report forms, including those from police or transport authorities.
- Records of lost income, including payslips and employer letters.
- Correspondence with insurers, including written notifications of claim initiation.
SIRA advises that claims for serious injury must be made within 3 years of the accident, unless the claim is for a lifetime care arrangement, which may have different timeframes. It is critical to notify your insurer as soon as possible, as delays may affect eligibility for benefits.
Time limits, disputes and when to seek advice
There is a 3-year time limit from the date of the accident to begin a claim for damages under the Motor Accident Injuries Act 2017. This applies regardless of when symptoms first appeared or when a diagnosis was confirmed. If you miss this deadline, you may not be able to claim damages, even if you have a serious injury.
If your claim is rejected or you disagree with the insurer’s assessment of your injury, you may request a review. SIRA provides a formal dispute resolution process for CTP claims. You can also seek independent medical assessment if you believe the initial assessment was inaccurate.
A common mistake is assuming that a long-term injury automatically qualifies as serious. SIRA’s guidelines clarify that even injuries that persist for years may not meet the threshold if they do not result in a permanent impairment of at least 15% or a significant loss of function. For example, a person with chronic back pain that has not been assessed for WPI may not qualify, even if they have been in treatment for over a year.
A realistic example: A 42-year-old driver was involved in a rear-end collision in Sydney in February 2025. The accident caused a spinal fracture, which required surgery and resulted in permanent nerve damage. After 18 months of treatment, a WPI assessment confirmed a 22% impairment. The medical team documented a loss of mobility and inability to return to manual labour. This case met the serious injury threshold under SIRA’s criteria and allowed for a claim for damages, including future care needs and loss of earnings.
Next steps
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.