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).
If you've suffered a traumatic brain injury in a motor accident in Auburn, understanding how to challenge a CTP claim decision is critical. NSW's Compulsory Third Party (CTP) scheme provides compensation for injuries, but disputes over claim outcomes often arise. This article explains the formal dispute resolution options available under the Motor Accident Injuries Act 2017, how SIRA handles brain injury claims, and practical steps to challenge insurer decisions.
How CTP Disputes Work for Traumatic Brain Injuries
Traumatic brain injuries (TBIs) are classified as 'threshold injuries' under NSW CTP rules, meaning they qualify for statutory benefits like weekly payments and treatment coverage. However, disputes may occur if an insurer disputes the severity of the injury, the link to the accident, or the claimant's entitlement to additional damages. SIRA assesses all claims based on the Motor Accident Guidelines, which define TBI as an injury requiring medical treatment and resulting in a whole person impairment rating of 10% or more.
Steps to Challenge a CTP Claim Decision
- Request an internal review: If your claim is denied or reduced, you can ask SIRA to review its decision. This process typically takes 28 days and requires submitting new evidence, such as updated medical records or expert opinions. For example, if a doctor's report fails to document cognitive impairments, a neuropsychologist's assessment may be necessary to challenge the decision.
- Escalate to the Personal Injury Commission: If the internal review is unsatisfactory, you can refer the matter to the Personal Injury Commission (PIC). The PIC will appoint an independent medical expert to reassess the claim. This process can take up to 12 months and is typically used for complex cases involving long-term brain injury effects.
- Legal review: In rare cases, claimants may seek legal assistance to challenge SIRA's interpretation of the law. A solicitor can help argue that the injury meets the 'threshold injury' definition or that the claimant is entitled to additional compensation for non-economic losses.
Key Evidence for Disputes
To successfully challenge a CTP decision, you'll need:
- Medical records showing a TBI diagnosis, treatment history, and ongoing symptoms
- Accident reports confirming the injury occurred in a motor vehicle accident
- Witness statements or CCTV footage supporting the claim
- Expert opinions from neuropsychologists or neurologists
Time Limits and Practical Considerations
You have 52 weeks from the accident date to claim statutory benefits, but disputes over brain injuries may require longer timelines. For example, if a claimant develops post-concussion syndrome months after the accident, they may need to provide evidence of ongoing symptoms to challenge a decision to terminate benefits. Always act quickly to preserve evidence and meet SIRA's deadlines.
When to Seek Legal Advice
Disputes over traumatic brain injuries often involve complex medical and legal issues. A solicitor can help you:
- Navigate SIRA's internal review process
- Prepare a strong case for the Personal Injury Commission
- Challenge incorrect interpretations of the Motor Accident Injuries Act 2017
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.