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 from motor accidents in NSW can lead to complex disputes over compensation. If you're in the Illawarra or South Coast regions, understanding the dispute resolution options under the NSW Compulsory Third Party (CTP) scheme is critical. This article explains how SIRA handles spinal injury claims, the steps to challenge a decision, and the legal boundaries you must consider.
How SIRA Handles Spinal Injury Claims
Under the Motor Accident Injuries Act 2017, spinal injuries are classified as 'threshold injuries' if they meet specific medical criteria. SIRA evaluates claims based on clinical evidence, including MRI scans, neurological assessments, and medical reports. For spinal injuries, the key is proving a 'spinal nerve-root injury producing neurological signs' as defined in the Motor Accident Guidelines. This distinction is crucial because threshold injuries typically qualify for statutory benefits like weekly payments and treatment coverage.
If your claim involves a spinal injury, SIRA will assess whether your injury meets the 'only injuries' test. This means your claim must not include other injuries that could extend benefits beyond the 52-week statutory limit. For example, if a spinal injury is combined with a broken arm, the 52-week cap may apply to both, reducing the total weekly payment. This rule is outlined in s 4.4 of the Motor Accident Injuries Act 2017.
Dispute Resolution Options for Spinal Injuries
If you disagree with SIRA's decision on your spinal injury claim, you have two main options: internal review and external review. First, you can request an internal review by SIRA. This involves submitting fresh evidence, such as a second medical opinion or updated diagnostic reports. SIRA will reassess your claim based on the new information.
If the internal review does not resolve the dispute, you can apply for an external review by the Personal Injury Commission (PIC). The PIC will examine whether SIRA's decision was legally sound. This process is outlined in the Motor Accident Injuries Regulation 2017, which specifies that external reviews are limited to legal and procedural errors, not medical disagreements.
For spinal injuries, it's essential to understand that the PIC cannot overturn a medical assessment unless there is evidence of a misinterpretation of the guidelines. For example, if SIRA incorrectly classified a spinal injury as a 'threshold injury' when it should have been deemed a 'whole person impairment, ' the PIC may intervene. However, the PIC cannot replace the medical opinion of a specialist.
Practical Steps for Claimants
To challenge a decision on a spinal injury claim, you must act quickly. SIRA allows 28 days from the date of a decision to request an internal review. If you apply for an external review, you have 28 days from the internal review outcome. Delays can result in missed opportunities to challenge a decision.
Key evidence to gather includes: medical records detailing the spinal injury, MRI or CT scan reports, and a detailed account of how the injury affects your daily life. For example, if your injury causes chronic pain or mobility issues, you should document how this impacts your ability to work or perform routine tasks.
You should also preserve any accident-related evidence, such as police reports, witness statements, and photographs of the scene. These can support your claim and help demonstrate the severity of the injury.
Time Limits and When to Seek Advice
Spinal injury claims must be submitted to SIRA within 52 weeks of the accident. If you miss this deadline, you may lose access to statutory benefits. However, if your claim involves a dispute over the injury's classification, you can still challenge a decision after the 52-week period, provided you act within the review timeframes.
It's important to note that disputes over spinal injuries can take months to resolve. For example, if SIRA initially denies a claim for a herniated disc but later accepts it after a medical review, the process can take up to 12 months. During this time, you should seek legal advice if you believe SIRA is not following the guidelines correctly.
Example: A Spinal Injury Dispute in the Illawarra
Consider a hypothetical case: a cyclist in the Illawarra suffers a spinal injury after a collision with a car. SIRA initially classifies the injury as a threshold injury, but the claimant believes it meets the criteria for a whole person impairment. The claimant requests an internal review, providing a second opinion from a neurologist. SIRA reclassifies the injury, leading to a higher weekly payment. This example shows how evidence and medical assessments can influence dispute outcomes.
When to Seek Legal Advice
If you're unsure whether your spinal injury qualifies for benefits, or if you believe SIRA has made an error in assessing your claim, it's essential to seek legal advice. A solicitor can help you understand your options, prepare for reviews, and ensure you meet all deadlines.
Final Steps for Claimants
If you're in the Illawarra or South Coast and facing a dispute over a spinal injury claim, the first step is to review SIRA's decision and gather all relevant evidence. If you need assistance with the dispute resolution process, you can complete the quick, no obligation enquiry form to request contact about your circumstances.