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).
When a motor accident occurs during work-related driving in NSW, claimants may face disputes between the Personal Injury Commission (PIC) and workers compensation authorities. This article explains what the PIC expects when handling such disputes, the legal boundaries, and practical steps for claimants in Greater Sydney.
How the PIC Handles CTP Claims During Workers Compensation
The PIC administers NSW’s Compulsory Third Party (CTP) scheme under the Motor Accident Injuries Act 2017. If a claimant is also receiving workers compensation, the PIC and workers compensation authorities operate as separate schemes. The PIC focuses on injuries caused by motor vehicle accidents, while workers compensation covers injuries sustained during work. Disputes arise when the PIC questions whether an injury qualifies for CTP benefits, especially if the injury is also covered under workers compensation.
The PIC expects claimants to provide evidence that the injury was caused by a motor vehicle accident and not solely by work-related activities. For example, if a worker was injured in a car crash while commuting to a work-related meeting, the PIC may require documentation proving the accident occurred outside the scope of employment. This distinction is critical, as workers compensation typically covers injuries sustained during work hours or work-related travel.
Practical Steps and Evidence for Disputes
To resolve disputes, the PIC requires specific evidence. Claimants should:
- Document the accident scene: Photographs, witness statements, and police reports are essential to establish the accident’s circumstances.
- Provide medical records: These must clearly link the injury to the motor vehicle accident. The PIC may request medical opinions confirming the injury’s origin.
- Clarify work-related activities: If the accident occurred during work hours or on company property, the claimant must demonstrate that the injury was not solely due to the motor accident.
The PIC also scrutinizes whether the injury meets the threshold for CTP benefits. Threshold injuries, such as soft tissue damage, must satisfy the spinal nerve-root qualification outlined in the Motor Accident Guidelines. If the injury is classified as a threshold injury, the PIC may dispute ongoing weekly payments after 52 weeks, as the scheme limits benefits for such cases.
Time Limits and Dispute Resolution
CTP claims must be made within 52 weeks of the accident, unless the claimant is receiving weekly payments. If a dispute arises, the PIC may initiate an internal review or refer the matter to the NSW Civil and Administrative Tribunal (NCAT). Claimants should note that the PIC’s decision is final unless there is a legal challenge, which requires a separate process.
The PIC’s internal review pathway allows claimants to challenge decisions by submitting new evidence or disputing the interpretation of medical records. However, the PIC does not guarantee a change in its decision. Claimants should seek legal advice if the dispute involves complex medical evidence or if the PIC’s interpretation conflicts with workers compensation assessments.
Example Scenario
Consider a scenario where a worker was injured in a car crash while driving to a client meeting. The worker is on workers compensation for a back injury sustained during a work-related task. The PIC may dispute the CTP claim if the injury is primarily attributed to the work activity, not the motor accident. The claimant must provide evidence that the injury was caused by the crash, such as medical records showing the injury’s origin and witness statements confirming the accident occurred outside work hours.
Next Steps
If the PIC disputes your CTP claim while you are on workers compensation, it is crucial to act promptly. The PIC’s decision may affect your access to benefits, and disputes can delay compensation. To request contact about your circumstances, complete the quick, no obligation enquiry form.