What changed for traumatic brain injury claims after 2017?
The 2017 reforms to NSW's Compulsory Third Party (CTP) insurance scheme significantly altered how traumatic brain injuries (TBIs) are assessed and compensated. Under the Motor Accident Injuries Act 2017, SIRA (State Insurance Regulatory Authority) now applies stricter guidelines to determine whether a TBI qualifies for benefits. Key changes include revised injury thresholds, updated assessment criteria, and clearer rules on long-term support. These reforms aim to ensure claims are evaluated based on medical evidence rather than subjective claims.
How SIRA assesses traumatic brain injury claims
SIRA evaluates TBI claims using the Motor Accident Guidelines, which define specific clinical signs and symptoms. For a TBI to qualify, it must meet the 'threshold injury' criteria outlined in the guidelines. This includes neurological signs such as impaired coordination, memory loss, or changes in speech. The 2017 reforms clarified that injuries requiring a spinal nerve-root injury with neurological signs (excluding radiculopathy) still count as soft tissue injuries under the scheme.
The assessment process now prioritises objective medical evidence, such as MRI scans, neurological exams, and specialist reports. Claimants must provide documentation showing a direct link between the accident and the TBI. SIRA also introduced a 'whole person impairment' test for more severe injuries, which considers long-term functional limitations.
Evidence required for a traumatic brain injury claim
To support a TBI claim, claimants must gather specific evidence:
- Medical records confirming the injury, including imaging and specialist reports
- A detailed accident report from the police or insurance provider
- Witness statements or CCTV footage
- Income records to establish lost earnings
- A completed SIRA claim form with accurate details
SIRA may request additional information, such as a neurological assessment from a registered medical practitioner. Claims lacking sufficient evidence may be delayed or rejected, highlighting the importance of thorough documentation.
Time limits and dispute resolution
Claimants must notify their insurer within 52 weeks of the accident, as per the Motor Accident Injuries Act 2017. If a TBI is classified as a 'threshold injury, ' benefits are generally limited to 52 weeks unless the claimant can prove more severe impairment. Disputes over injury severity or compensation can be escalated to the NSW Civil and Administrative Tribunal (NCAT) for review.
When to seek legal advice
The 2017 reforms introduced complex rules that can affect claim outcomes. For example, a TBI that meets the 'threshold injury' definition may still qualify for long-term support if it results in significant functional impairment. Legal professionals can help claimants understand their rights, challenge incorrect assessments, and ensure all evidence is properly submitted.
Example of a TBI claim under the new rules
Consider a cyclist who suffered a head injury after a collision. Medical records show memory loss, difficulty concentrating, and a reduced ability to work. Under the 2017 reforms, SIRA would assess whether these symptoms meet the threshold injury criteria. If the claimant can demonstrate that the injury prevents them from working for 52 weeks or more, they may qualify for weekly income payments and long-term support.
Next steps for claimants
The 2017 reforms have made TBI claims more complex, with tighter rules on evidence and time limits. Claimants should act quickly to gather medical records, notify insurers, and seek legal advice if their claim is denied. Every case is unique, and the outcome depends on the facts, applicable law, and the strength of supporting evidence.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.