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 (TBI) in a motor vehicle accident in Albury, NSW, understanding what evidence to retain for your CTP claim is critical. Under NSW law, claims for TBI require specific documentation to prove the injury's existence, severity, and connection to the accident. This article explains the evidence needed, how SIRA evaluates TBI claims, and practical steps to support your case.
What Evidence is Needed for a TBI CTP Claim?
New South Wales' Motor Accident Injuries Act 2017 governs CTP claims, including those for TBI. To establish a valid claim, you must provide evidence that:
- The injury is a threshold injury, SIRA defines threshold injuries as those requiring medical treatment and meeting specific clinical criteria. For TBI, this includes symptoms like confusion, memory loss, or difficulty concentrating.
- The injury resulted from the accident, Medical records must link the TBI to the accident, not a pre-existing condition.
- The injury meets the 52-week benefit period, If your only injuries are threshold injuries, benefits like weekly payments and treatment benefits generally stop after 52 weeks under s 4.4 of the Motor Accident Injuries Act 2017.
Key evidence includes:
- Medical records, Detailed reports from neurologists or GPs confirming the TBI, including imaging (e.g., CT scans) and clinical notes.
- Accident reports, Police reports or statements from the driver and witnesses.
- Witness statements, Accounts from people who saw the accident or noticed your symptoms.
- Photographs, Of the accident scene, vehicle damage, and any visible injuries.
- Income records, To support claims for lost wages or reduced earning capacity.
How Does SIRA Evaluate TBI Claims?
SIRA assesses TBI claims based on the Motor Accident Guidelines, which outline clinical criteria for threshold injuries. For example, a TBI must involve a spinal nerve-root injury with neurological signs, excluding radiculopathy unless specific clinical signs are present.
SIRA also considers:
- Medical opinion, Whether a treating doctor has confirmed the injury meets the threshold definition.
- Consistency of evidence, Discrepancies between medical records and witness statements may weaken your claim.
- Duration of symptoms, Prolonged symptoms like memory loss or cognitive impairment may support a higher impairment rating.
A hypothetical example: If you suffered a concussion after a car crash, your GP's notes documenting confusion and memory loss, along with a CT scan showing no structural damage, would support a TBI claim. However, if symptoms resolve within weeks, SIRA may classify the injury as a threshold injury with limited benefits.
Practical Steps to Support Your TBI Claim
- Seek immediate medical attention, Even if symptoms seem minor, a medical professional can document the injury.
- Preserve accident details, Keep police reports, witness contact information, and photographs of the scene.
- Track symptoms, Maintain a diary of cognitive changes, mood swings, or physical symptoms.
- Communicate with your insurer, Request copies of all correspondence and ensure you understand the claims process.
- Consider independent medical assessment, If your claim is disputed, an independent expert may be required to assess the injury.
Time Limits and Dispute Options
You have 6 months from the date of the accident to notify your insurer of a claim under the Motor Accident Injuries Act 2017. If you fail to meet this deadline, you may lose your right to benefits.
If your claim is rejected, you can:
- Request a review, SIRA allows for reconsideration of claims based on new evidence.
- Seek legal advice, A solicitor can help challenge a decision or negotiate a settlement.
When to Seek Legal Advice
Consult a lawyer if:
- Your injury is complex or overlaps with workers' compensation.
- Your claim is denied and you need to dispute the decision.
- You need help navigating SIRA's assessment process.
Final Steps
Retaining the right evidence is crucial for a successful TBI CTP claim. If you're unsure whether your records meet SIRA's requirements, or if your claim has been rejected, seek professional guidance. 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.