Where a person's only injuries resulting from the accident are threshold injuries, weekly benefits and treatment and care generally cease after 52 weeks (ss 3.11 and 3.28).
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 vision loss from a motor accident in Illawarra or South Coast NSW and are disputing your CTP claim, understanding your options is critical. Under the Motor Accident Injuries Act 2017, disputes over eye injuries or blindness must be resolved through specific legal pathways. This article explains how to challenge a claim, what evidence matters, and how SIRA handles vision loss cases in regional NSW. It also outlines time limits and when to seek legal advice.
How SIRA Handles Vision Loss Claims
SIRA (State Insurance Regulatory Authority) administers CTP claims under the Motor Accident Injuries Act 2017. For eye injuries, claims must demonstrate a 'threshold injury', a defined level of harm under the Motor Accident Guidelines. Vision loss qualifies as a threshold injury if it meets specific medical criteria, such as permanent visual impairment or blindness. SIRA assesses claims based on medical reports, not fault, and may limit benefits after 52 weeks if only threshold injuries are involved (s 4.4 of the Act).
Evidence Required for Vision Loss Claims
To dispute a claim or challenge a decision, you must provide detailed evidence. Key documents include:
- Medical records showing the extent of vision loss (e.g., eye exam reports, ophthalmologist notes)
- Accident reports from police or witnesses
- Witness statements confirming the incident
- Income records to support claims for lost earnings
- SIRA correspondence outlining the claim's status
Medical evidence is particularly critical. SIRA requires clinical signs like visual acuity measurements or documented loss of sight. If your claim is denied, you may need an independent medical opinion to challenge the assessment.
Dispute Resolution Options
- Internal Review: SIRA allows applicants to request a review of their claim decision. This process involves a reassessment of medical evidence and claim calculations. You must submit the request within 28 days of receiving the decision (s 12.2 of the Motor Accident Injuries Regulation 2017).
- Personal Injury Commission (PIC) Mediation: If the internal review fails, you can apply for mediation through the PIC. This involves a neutral third party reviewing the claim and proposing a resolution. Mediation is free but not guaranteed to result in a changed decision.
- External Review: For complex disputes, you may seek an external review by a tribunal. This is a formal legal process where a judge assesses the claim based on evidence and legal principles. It is the final step and requires a strong case.
Regional Considerations for Illawarra and South Coast
While SIRA operates statewide, regional areas like Illawarra and South Coast may have limited access to legal resources. Claimants should contact SIRA's regional offices for assistance. The Personal Injury Commission also offers mediation services in key locations, including Wollongong and Nowra. Be aware that delays in processing claims are common in rural areas, so prompt action is essential.
When to Seek Legal Advice
Disputes over vision loss claims are complex. A solicitor can help you:
- Navigate SIRA's internal review process
- Challenge medical assessments
- File for mediation or external review
- Understand your rights under the Act
Legal advice is particularly important if your claim involves long-term vision impairment or if SIRA has denied your application. An experienced lawyer can assess whether your case meets the threshold injury criteria and whether you have grounds for a dispute.
Next Steps
Time limits apply to all CTP claims. If your vision loss claim has been disputed or denied, act quickly. SIRA requires evidence to be submitted within 28 days of a decision, and legal action must be initiated before the expiry of the 52-week statutory benefit period. Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.