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).
Spinal injuries can severely limit a person's ability to perform everyday tasks like dressing, cooking, or working. In New South Wales, the Compulsory Third Party (CTP) scheme provides support for spinal injuries, but claimants must understand how their condition affects daily activities and what evidence is needed to secure benefits. This article explains how spinal injuries impact daily life, what CTP claims cover, and practical steps to take when managing a spinal injury claim.
How Spinal Injuries Affect Daily Activities
Spinal injuries, including fractures, dislocations, or nerve damage, can cause chronic pain, mobility issues, and loss of function. For example, a person with a herniated disc may struggle to lift objects or stand for prolonged periods. These limitations can prevent someone from working, caring for family, or performing household tasks. The severity of the injury determines whether a claimant qualifies for benefits under the CTP scheme.
What CTP Claims Cover for Spinal Injuries
Under the Motor Accident Injuries Act 2017, claimants with spinal injuries may be eligible for:
- Treatment and care benefits to cover medical expenses, physiotherapy, and equipment like braces.
- Weekly income payments if the injury prevents them from working for 52 weeks or more.
- Assistance with daily living through benefits like home help or modifications to enable independent living.
The CTP insurer must assess whether the injury meets the 'threshold injury' definition in the Motor Accident Guidelines. For example, a spinal injury causing radiculopathy (nerve-related pain) with specific clinical signs may qualify for benefits.
Evidence Needed for Daily Activity Limitations
To support a claim, injured people must provide:
- Medical records showing the injury's impact on mobility, pain levels, and recovery progress.
- Accident reports detailing how the injury occurred.
- Witness statements or photos of the accident scene.
- Evidence of daily activity limitations, such as:
- A doctor's note stating inability to work.
- Records of time spent on mobility aids like crutches.
- Statements from family or employers about reduced capacity for household or work tasks.
How CTP Insurers Assess Daily Functioning
NSW CTP insurers evaluate how the injury affects a person's ability to perform 'usual daily activities' as defined in the Motor Accident Guidelines. This includes tasks like:
- Dressing or grooming.
- Preparing meals.
- Traveling to appointments.
- Performing work-related duties.
Insurers may require a medical report from a specialist confirming the injury's impact. For example, a person with a spinal injury requiring a walking aid for 12 months may qualify for weekly payments under the 52-week statutory benefit rules.
Practical Steps for Spinal Injury Claimants
- Seek immediate medical attention to document the injury's effects on daily activities.
- Keep detailed records of all medical treatments, therapy sessions, and equipment used.
- Notify the CTP insurer within 90 days of the accident to avoid missing time limits.
- Request a medical assessment to confirm how the injury limits daily functioning.
When to Seek Legal Advice
Claimants should consult a solicitor if:
- The insurer denies benefits despite medical evidence.
- The injury requires long-term support, such as home modifications or assistive devices.
- The claimant is unsure whether their injury meets the threshold for benefits.
Time Limits and Dispute Options
CTP claimants must notify the insurer within 90 days of the accident. If a dispute arises, they can:
- Request a review of the insurer's decision.
- Apply to the NSW Civil and Administrative Tribunal (NCAT) for a binding ruling.
Final Considerations
Spinal injuries can have lasting effects on daily life, but the CTP scheme provides support for treatment, income, and assistance. Claimants must provide clear evidence of how their injury limits activities and seek legal advice if their claim is denied. Every claim depends on its own facts.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.