Traumatic brain injury claims under NSW CTP laws
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).
Traumatic brain injuries (TBIs) are among the most serious injuries covered by NSW Compulsory Third Party (CTP) insurance. Under the Motor Accident Injuries Act 2017, injured parties can claim treatment and care benefits, weekly income payments, and compensation for long-term impairments. This article explains how SIRA evaluates TBI claims, using practical examples from the Newcastle and Hunter regions.
How SIRA assesses traumatic brain injury claims
SIRA evaluates TBI claims based on medical evidence and the severity of the injury. A traumatic brain injury is defined as an injury to the brain caused by an external force, such as a car accident, fall, or sports injury. To qualify for benefits, the injury must meet the 'threshold injury' criteria outlined in the Motor Accident Guidelines. This includes neurological signs like loss of consciousness, confusion, or memory problems.
For example, a cyclist in Newcastle who suffered a TBI after being hit by a car would need medical records showing symptoms such as prolonged confusion, difficulty concentrating, or memory loss. SIRA assesses whether the injury meets the threshold by reviewing clinical reports and imaging results. If the injury is classified as a 'threshold injury, ' the injured person may be eligible for weekly income payments and treatment benefits.
Practical examples from Newcastle and Hunter
In the Hunter region, a 35-year-old motorcyclist who suffered a TBI after a collision with a car received weekly income payments for 52 weeks. SIRA determined the injury met the threshold based on MRI scans and a neurologist's report confirming cognitive impairments. After 52 weeks, the person was reassessed and found to have a whole person impairment (WPI) of 15%, qualifying them for a lump sum compensation payment.
In Newcastle, a pedestrian who suffered a TBI from a hit-and-run accident received treatment benefits for 26 weeks. SIRA's assessment included a detailed medical history, witness statements, and a neuropsychological report confirming ongoing memory and attention issues. This example highlights how SIRA's regional offices handle TBI claims based on evidence, not just the location of the accident.
Time limits and when to seek advice
CTP claims must be submitted within 52 weeks of the accident for weekly income payments. However, claims for long-term impairments can be made at any time, provided the injury is not a 'threshold injury' only. If the injury results in a whole person impairment of 10% or more, the injured person may be eligible for a lump sum payment.
Disputes can arise if SIRA disputes the severity of the injury or the claimant's ability to work. In such cases, seeking independent legal advice is crucial. For example, a claimant in the Hunter region who received a lower WPI rating may need a solicitor to challenge the assessment and provide evidence of ongoing impairments.
Next steps for claimants
If you or a loved one has suffered a traumatic brain injury in NSW, it is essential to act quickly. Gather medical records, accident reports, and witness statements to support your claim. SIRA's regional offices in Newcastle and Hunter handle TBI claims, but the process can be complex. For personalized guidance, complete the quick, no obligation enquiry form to request contact about your circumstances.