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 under the NSW Compulsory Third Party (CTP) scheme are eligible for compensation if they meet specific medical and legal criteria. The scheme covers injuries resulting from motor vehicle accidents, including spinal injuries, but eligibility depends on the nature of the injury and evidence of its impact. In regional NSW, the rules are the same as in metropolitan areas, and claimants must demonstrate their injury meets the threshold injury definition under the Motor Accident Injuries Act 2017.
Key Eligibility Criteria for Spinal Injuries
The NSW CTP scheme defines 'threshold injury' as an injury that results in a 'significant and lasting' impact on a person's daily life. For spinal injuries, this includes conditions like herniated discs, spinal stenosis, or fractures that cause neurological symptoms. The Spinal Injury Guidelines (2023) specify that injuries must produce neurological signs beyond radiculopathy (nerve root irritation) to qualify as threshold injuries. For example, a herniated disc causing weakness in a leg or bladder dysfunction would meet this threshold.
How SIRA Determines Eligibility
The State Insurance Regulatory Authority (SIRA) assesses claims based on medical evidence. Claimants must provide:
- A diagnosis from a medical practitioner confirming the spinal injury
- Evidence of how the injury affects daily activities (e.g., mobility, work capacity)
- Documentation of treatment received
In regional NSW, claimants may need to seek specialist assessments if their injury is complex. SIRA uses the Motor Accident Guidelines to evaluate whether the injury meets the threshold definition.
Practical Steps for Claimants
- Seek immediate medical attention to document the injury and its effects.
- Keep detailed records of treatment, including specialist reports and therapy notes.
- Report the accident to the at-fault driver's insurer within 52 weeks of the incident.
- Submit a claim form through SIRA's online portal or by mail.
- Request a review if the insurer disputes eligibility, as claimants have the right to challenge decisions.
Time Limits and Dispute Options
Claimants must notify the insurer within 52 weeks of the accident. If the injury is a 'threshold injury', benefits like weekly payments and treatment coverage stop after 52 weeks unless the injury is classified as a 'whole person impairment' (a permanent and severe disability). For example, a spinal injury causing partial paralysis would qualify for ongoing benefits.
Disputes over eligibility can be resolved through SIRA's internal review process or by seeking legal advice. Claimants should act quickly, as delays may affect the ability to prove the injury's impact.
When to Seek Legal Advice
Legal assistance is recommended if:
- The injury involves complex medical evidence
- The claimant is unsure if their injury meets the threshold definition
- The insurer denies the claim without clear reasoning
- The injury requires long-term support or has overlapping claims with workers' compensation
Example Scenario
A cyclist in regional NSW sustains a spinal injury after a collision. Medical records show the injury caused temporary weakness in their legs and required two weeks of bed rest. While the injury does not meet the whole person impairment threshold, it qualifies as a threshold injury because it significantly impacted their ability to work and perform daily tasks. The claimant receives 52 weeks of weekly payments and treatment coverage under the CTP scheme.
Next Steps
CTP scheme eligibility for spinal injuries depends on the injury's severity and evidence of its impact. In regional NSW, claimants must follow the same process as in metropolitan areas. To discuss your circumstances, complete the quick, no obligation enquiry form.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.