Shoulder Injuries and the 2017 CTP Reforms in NSW
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 sustained a shoulder injury in a car accident in New South Wales, the 2017 reforms to the Compulsory Third Party (CTP) scheme may affect your claim. These reforms introduced changes to how injuries are assessed, particularly for soft-tissue injuries like rotator cuff tears and shoulder trauma. This article explains what changed, how rural and remote claimants are treated, and practical steps to take.
How the 2017 Reforms Changed Shoulder Injury Claims
Before 2017, shoulder injuries were often treated as minor and eligible for limited benefits. The reforms now require claimants to demonstrate that their injury meets the 'threshold injury' definition in the Motor Accident Injuries Act 2017. For shoulder injuries, this means proving a spinal nerve-root injury with neurological signs, such as weakness or numbness, rather than relying on general pain or swelling.
The reforms also clarified that injuries like rotator cuff tears or dislocations may qualify as threshold injuries if they meet specific clinical criteria. However, claims for these injuries are subject to a 52-week limit on statutory benefits, unless the injury results in long-term impairment. This means weekly payments and treatment benefits stop after 52 weeks unless the injury is severe enough to qualify for ongoing compensation.
Practical Steps for Rural and Remote Claimants
Claimants in rural or remote areas may face additional challenges, such as limited access to specialist medical facilities. To support your claim, you should:
- Obtain a detailed medical report from a local doctor or specialist, even if they cannot provide all diagnostic imaging.
- Document any symptoms that align with the threshold injury definition, such as reduced range of motion or muscle weakness.
- Preserve evidence of the accident, including photographs of the scene, witness statements, and police reports.
- Contact the at-fault driver’s insurer promptly to start the claims process.
Time Limits and Dispute Options
You have 52 weeks from the accident date to claim statutory benefits for threshold injuries. If your injury does not meet the threshold definition, you may still pursue a common law damages claim, but this requires proving fault and long-term consequences. Claims for non-threshold injuries are subject to strict time limits and must be supported by medical evidence.
If your claim is disputed, you can request a review by the State Insurance Regulatory Authority (SIRA) or seek mediation through the NSW Civil and Administrative Tribunal (NCAT). In rural areas, delays in accessing specialist assessments may affect the timeline, so it is important to act quickly.
Example: Shoulder Injury in a Rural Setting
Consider a scenario where a farmer sustains a rotator cuff tear in a car accident. Under the 2017 reforms, the injury may qualify as a threshold injury if it causes neurological signs like arm weakness. However, the farmer’s claim for weekly benefits would stop after 52 weeks unless the injury results in long-term impairment. If the injury worsens and requires surgery, the claimant may need to re-evaluate their entitlements.
When to Seek Legal Advice
The 2017 reforms have created complex rules about what injuries qualify for benefits and how claims are assessed. If you are unsure whether your shoulder injury meets the threshold definition, or if your claim has been denied, it is important to seek legal advice. A solicitor can help you understand your options and ensure your claim is processed correctly.
Next Steps
CTP claims depend on the date of the accident, the nature of the injury, and the evidence you provide. If you are in rural or remote NSW and have questions about your shoulder injury claim, complete the quick, no obligation enquiry form to request contact about your circumstances.