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).
When a worker is injured in a motor accident while performing work-related duties, their claim for Compulsory Third Party (CTP) compensation may overlap with workers compensation benefits. In New South Wales, the State Insurance Regulatory Authority (SIRA) oversees how these overlapping entitlements are managed, particularly in areas like Albury. This article explains how SIRA determines eligibility, handles disputes, and ensures benefits are calculated correctly when a claimant receives both CTP and workers compensation payments.
How SIRA Determines Eligibility for Overlapping Claims
SIRA assesses whether a motor accident injury qualifies as a work-related injury under the Workers Compensation Act 1996. If the accident occurred during work duties, the injured person may be eligible for both CTP benefits and workers compensation. However, SIRA must determine if the injury meets the threshold for CTP claims under the Motor Accident Injuries Act 2017. For example, if a delivery driver is injured in a crash while delivering goods, SIRA will evaluate whether the injury meets the soft-tissue or whole-person impairment thresholds.
What Happens if a CTP Claimant is Receiving Workers Compensation?
If a claimant is found to be receiving workers compensation payments, SIRA must ensure benefits are not double-counted. Under the Motor Accident Injuries Act 2017, weekly income payments and treatment benefits are limited to 52 weeks for threshold injuries. If the injury is classified as a threshold injury, CTP benefits may be reduced or adjusted to avoid overpayment. For non-threshold injuries, SIRA will calculate benefits based on the injury’s impact on the claimant’s earning capacity.
How SIRA Handles Disputes Over Overlapping Benefits
Disputes often arise when claimants receive both CTP and workers compensation payments. SIRA resolves these through its dispute resolution process, which includes mediation and, if necessary, referral to the NSW Civil and Administrative Tribunal (NCAT). For instance, if a claimant argues their injury meets the whole-person impairment threshold while SIRA classifies it as a soft-tissue injury, the dispute will be resolved based on medical evidence and the Motor Accident Guidelines.
Practical Steps and Evidence to Gather
To support a CTP claim while on workers compensation, claimants must provide: medical records confirming the injury’s nature and severity, evidence of the accident (e.g., police reports, witness statements), and proof of workers compensation payments. SIRA may also request details about the claimant’s work duties to assess if the accident occurred during work-related activities.
Time Limits and When to Seek Advice
CTP claims must be made within 52 weeks of the accident for threshold injuries, while non-threshold claims have no strict time limit. However, workers compensation claims must be reported within 30 days of the injury. If a claimant is unsure about overlapping benefits or faces a dispute, seeking legal advice is crucial. SIRA’s guidelines provide a framework, but individual circumstances may require tailored guidance.
Example: A Delivery Driver’s Case
Consider a delivery driver injured in a crash while delivering packages. SIRA will assess whether the injury meets the soft-tissue threshold under the Motor Accident Guidelines. If the injury is classified as a threshold injury, CTP benefits will be limited to 52 weeks, and workers compensation payments will be adjusted to avoid double compensation. If the injury involves a spinal nerve-root injury with neurological signs, it may still qualify as a soft-tissue injury under the guidelines.
Next Steps
CTP claims and workers compensation overlap can be complex, especially when injuries fall between threshold and non-threshold categories. SIRA’s rules ensure benefits are calculated fairly, but claimants must provide accurate evidence and understand their rights. For personalized advice on how SIRA applies these rules in Albury, complete the quick, no obligation enquiry form.