How Insurers Assess Liability for Shoulder Injuries in NSW CTP Claims
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).
In New South Wales, insurers assess liability for shoulder injuries in Compulsory Third Party (CTP) claims by evaluating medical evidence, fault determination, and adherence to SIRA guidelines. Shoulder injuries, such as rotator cuff tears or dislocations, are common in car accidents and require specific documentation to establish a valid claim. This article explains the process insurers use to evaluate these claims and what claimants should know.
Key Factors in Liability Assessment
Insurers assess liability by considering:
- Medical evidence confirming the injury was caused by the accident, including imaging reports and specialist opinions.
- Fault determination, whether the accident was caused by another driver's negligence or a contributory fault.
- SIRA guidelines, the NSW government's framework for assessing injury severity and claim eligibility.
For example, a claimant with a rotator cuff tear from a collision must provide evidence linking the injury to the accident. SIRA's Motor Accident Guidelines outline how injuries are classified, including whether they meet the 'threshold injury' criteria for compensation.
Practical Steps for Claimants
To support a claim, injured persons should:
- Seek immediate medical attention to document the injury.
- Preserve accident details, such as police reports, witness statements, and photographs.
- Submit all medical records to the insurer, including specialist reports and treatment plans.
Common mistakes include delaying medical treatment or failing to document the injury's connection to the accident. These can weaken a claim.
Time Limits and Dispute Resolution
CTP claims must be made within 52 weeks of the accident if only 'threshold injuries' are involved. For more severe injuries, claimants may need to pursue a common law damages claim separately. If an insurer disputes liability, claimants can:
- Request a review of their claim through SIRA.
- Seek legal advice to challenge the insurer's assessment.
When to Seek Legal Advice
Claimants should consult a solicitor if:
- The injury is severe and exceeds SIRA's threshold criteria.
- The insurer disputes fault or refuses to pay.
- The claim involves complex issues like contributory fault or long-term care needs.
Next Steps
CTP entitlements depend on the accident date, injury type, and claim history. To discuss your circumstances, complete the quick, no obligation enquiry form.