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).
Soft tissue injuries in NSW motor accident claims are subject to specific limits under the Compulsory Third Party (CTP) scheme. The New South Wales Motor Accident Injuries Act 2017 (MAIA) and SIRA's guidelines define how these limits apply, determining when treatment benefits end and whether further compensation is available. This article explains how SIRA assesses soft tissue injury claims, the practical impact on claimants, and the legal boundaries insurers must follow.
How SIRA Defines Soft Tissue Injury Caps
Under the CTP scheme, soft tissue injuries are treated differently from more severe injuries. SIRA explains that soft tissue injuries include conditions like whiplash, sprains, and strains, but not fractures or neurological damage. The key legal rule is that treatment benefits for soft tissue injuries typically end after 52 weeks from the date of the accident, unless the injury meets the threshold for long-term impairment.
SIRA's guidelines state that the 52-week limit applies only if the injury is classified as a 'threshold injury' under the Motor Accident Guidelines. This means the injury must be minor and not require ongoing treatment. For example, a person with a minor neck strain that resolves within six months would fall under this cap. However, if the injury results in long-term impairment, such as chronic pain or reduced mobility, the claim may continue beyond 52 weeks.
Practical Steps for Claimants
If you've suffered a soft tissue injury in a motor accident, the following steps are crucial:
- Seek immediate medical attention to document the injury. A doctor's report is essential to prove the injury's nature and severity.
- Keep detailed records of all treatment, including medical bills, therapy sessions, and any correspondence with insurers.
- Notify your insurer within 52 weeks of the accident. Delays may affect your ability to claim treatment benefits.
- Understand SIRA's assessment criteria. If your injury is classified as a threshold injury, you may need to provide evidence that it meets the long-term impairment threshold to continue claiming.
Disputes and When to Seek Advice
Insurers may dispute the classification of your injury, arguing it falls within the 52-week cap. If your claim is denied or limited, you may need to:
- Request a review of SIRA's decision, providing additional medical evidence.
- Seek legal advice if the insurer refuses to reconsider or if you believe the injury meets the long-term impairment threshold.
It's important to note that the 52-week limit applies only to injuries that do not meet the threshold for long-term impairment. If your injury results in ongoing treatment or significant functional limitation, you may be eligible for continued benefits. Always consult a legal professional to understand how SIRA's guidelines apply to your specific case.
Next Steps
Time limits and procedural requirements can significantly impact your claim. To request contact about your circumstances, complete the quick, no obligation enquiry form.