Understanding Insurer Decisions in Wildlife Strike Accidents
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).
A motor vehicle accident involving a wildlife animal on a NSW road may result in a claim under the Compulsory Third Party (CTP) insurance scheme. Insurers assess these claims based on the Motor Accident Injuries Act 2017 and SIRA’s guidance, focusing on whether the injury arose from a motor vehicle accident, the nature and extent of the injury, and whether the claimant meets statutory thresholds for benefits or damages. In Greater Sydney, as elsewhere in NSW, the insurer’s decision will depend on medical evidence, accident details, and compliance with procedural requirements under the current CTP framework.
Legal Framework for Wildlife Strike Claims
The Motor Accident Injuries Act 2017 (MAIA) governs all CTP claims in NSW, including those arising from collisions with wildlife. The law does not distinguish between animal strikes and other types of motor vehicle accidents for the purpose of eligibility. If a person is injured while operating or riding in a motor vehicle due to a collision with a kangaroo, wallaby, emu, or other animal on a public road, they may be entitled to statutory benefits under the CTP scheme.
SIRA’s guidance confirms that a motor accident includes any incident involving a motor vehicle on a road where a person is injured as a result of the vehicle’s movement, including evasive actions such as swerving to avoid an animal. The insurer must assess whether the injury was caused by the accident and whether the claimant satisfies the legal requirements for benefits, including the threshold for damages.
Factors Insurers Consider in Decision-Making
Insurers evaluate wildlife strike claims using several key criteria:
- Whether the incident occurred on a road or road-related area, including private roads open to public use
- Whether the vehicle was in motion and the injury occurred during or immediately after the evasive action or impact
- Whether the claimant was a driver, passenger, pedestrian, cyclist, or motorcyclist at the time of the accident
- The nature and severity of the injury, including whether it constitutes a threshold injury under the Motor Accident Guidelines
- Whether the injury resulted in a whole person impairment (WPI) of 10% or more, which may allow a claim for damages
Insurers will review medical reports, accident scene details, and any available video or photographic evidence. They may also request a medical assessment to determine the extent of injury and its connection to the accident.
Evidence That Supports a Claim
To understand an insurer’s decision, claimants should ensure they have collected and preserved the following evidence:
- A police report, if one was filed at the scene
- Photographs or video of the accident site, vehicle damage, and any animal remains
- Witness contact details and statements
- Medical records from the time of the accident, including initial treatment and follow-up assessments
- A record of any lost income due to time off work
- A copy of the CTP insurer’s decision letter, if received
SIRA advises that claimants must notify their insurer within 6 months of the accident, or within 6 months of when they first became aware of a claimable injury, whichever is later. Failure to meet this deadline may prevent access to benefits.
When a Claim May Be Denied or Disputed
An insurer may deny a claim if they determine that:
- The injury did not arise from the motor vehicle accident
- The claimant was not in a vehicle at the time of impact
- The injury was pre-existing or unrelated to the accident
- The claimant failed to provide required evidence within the timeframe
If a claim is denied, the claimant may request a review under SIRA’s dispute resolution process. They may also apply to the NSW Civil and Administrative Tribunal (NCAT) for a determination if the dispute remains unresolved.
Hypothetical Example: Understanding a Decision
A driver in Sydney’s western suburbs was travelling on the M4 motorway when a kangaroo jumped in front of their car. The driver swerved to avoid it, lost control, and collided with a barrier. The driver sustained a whiplash injury and a minor concussion. They sought medical treatment within 48 hours and provided a medical report confirming the injury was consistent with a motor vehicle accident.
The insurer accepted the claim for treatment and care benefits and weekly income payments. However, they declined a claim for damages because the medical assessment showed a WPI of 8%, below the 10% threshold required for damages under the Motor Accident Guidelines.
The driver may request a review of the insurer’s decision on the WPI assessment. They may also seek a second medical opinion to support a higher impairment rating.
Practical Steps to Understand an Insurer’s Decision
To assess whether an insurer’s decision is legally sound, claimants should:
- Review the insurer’s written response, including any reasons for denial or limitation
- Check whether the insurer has applied the correct legal framework under the MAIA and Motor Accident Guidelines
- Verify that the medical evidence supports the insurer’s assessment of injury and causation
- Confirm that all procedural deadlines were met
If the claimant believes the decision is incorrect, they should contact SIRA for guidance or seek independent legal advice before initiating a formal dispute.
Next Steps
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.