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 injury in a motor accident in NSW, you may be eligible for compensation through the Compulsory Third Party (CTP) scheme. Vision loss claims require specific evidence to prove the injury's nature, extent, and connection to the accident. This article explains what records to retain, how SIRA evaluates claims, and practical steps for Illawarra and South Coast residents.
Medical Evidence Required for CTP Vision Loss Claims
Under NSW CTP rules, vision loss injuries must be supported by medical documentation. Key records include:
- Medical reports from ophthalmologists or optometrists detailing the injury's cause, diagnosis, and treatment.
- Expert reports from specialists confirming the injury meets the 'threshold injury' definition under the Motor Accident Injuries Act 2017.
- Pre-accident vision records (e.g., eye exams, glasses prescriptions) to establish baseline function.
- Post-accident vision tests showing measurable loss, such as visual acuity measurements or field test results.
- Documentation of treatment (e.g., surgeries, therapies) and any ongoing care needs.
SIRA requires evidence that the injury resulted from the accident and meets the legal threshold. For example, a 20% loss of visual field may qualify, while a 10% loss may not, depending on clinical assessment.
How SIRA Assesses Vision Loss Claims
SIRA evaluates claims based on the Motor Accident Guidelines and the Medical Evidence Guidelines. Key factors include:
- Clinical signs such as reduced visual acuity, eye movement restrictions, or optic nerve damage.
- Functional impact on daily activities (e.g., reading, driving, navigation).
- Consistency between medical records and the accident's circumstances.
SIRA may request additional assessments if records are unclear. For instance, if a claimant reports sudden blindness after a minor accident, SIRA might require an independent eye specialist's opinion to verify the injury's cause.
Records to Retain for CTP Claims
To support your claim, retain:
- Accident details: Police reports, witness statements, and photos of the scene.
- Medical records: All reports, test results, and correspondence with healthcare providers.
- Income records: Proof of lost earnings or additional costs (e.g., travel for treatments).
- Insurer correspondence: Emails or letters from the at-fault driver's insurer.
- Expert opinions: Reports from specialists confirming the injury's severity.
If your injury involves spinal nerve-root damage (e.g., optic nerve injury), ensure your medical team documents neurological signs beyond radiculopathy, as this may affect eligibility.
Time Limits and Dispute Resolution
CTP claims must be submitted within 52 weeks of the accident if the injury is classified as a 'threshold injury.' After this period, benefits for weekly income or treatment may stop, though long-term care costs could still qualify. If your injury exceeds the threshold, benefits may continue beyond 52 weeks.
Disputes over vision loss claims are resolved by SIRA's Dispute Resolution Service. You may need to provide additional evidence or undergo a medical review. For example, if your claim is rejected, you can request a reconsideration or review by an independent assessor.
When to Seek Legal Advice
Consult a solicitor if:
- Your injury involves complex medical conditions (e.g., glaucoma worsened by trauma).
- You're unsure whether your injury meets the threshold.
- You need help navigating SIRA's assessment process.
- You face a dispute over your claim's value.
A lawyer can help ensure your records meet CTP requirements and challenge decisions that unfairly limit your benefits.
Practical Example
Consider a claimant who suffered a sudden loss of peripheral vision after a car accident on the South Coast. Their ophthalmologist documented a 30% reduction in visual field and linked it to the accident. SIRA accepted the claim because the injury met the threshold and the medical records were clear. This example shows how detailed documentation improves claim outcomes.
Next Steps
CTP vision loss claims depend on accurate evidence and timely action. Retain all medical and accident records, and contact SIRA within 52 weeks. If your claim is denied or you need help appealing a decision, seek legal advice. 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.