Understanding CTP Claims for Wrist Fractures in NSW
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 wrist fracture sustained during a motor accident in Greater Sydney may be covered under the NSW Compulsory Third Party (CTP) insurance scheme. Insurers assess these claims based on the Motor Accident Injuries Act 2017 (MAIA), which sets out the rules for compensation. The outcome depends on whether the injury meets the legal thresholds for benefits, not on who was at fault. Insurers will review medical evidence, treatment records and accident details to determine eligibility for treatment and care benefits, weekly income payments, and, where applicable, damages for pain and suffering.
What Insurers Consider in Wrist Fracture Claims
Insurers assess wrist fracture claims using several key factors. First, they confirm whether the injury occurred in a motor accident involving a motor vehicle, as defined under the MAIA. This includes collisions on public roads, in car parks, or on private property if the vehicle was being used in a way that constitutes a motor vehicle accident under the law. Second, they assess the nature and severity of the fracture using medical evidence. A diagnosis of a wrist fracture from a medical practitioner, supported by imaging such as an X-ray or MRI, is essential.
Insurers also consider whether the injury qualifies as a threshold injury under the MAIA. A wrist fracture may be considered a threshold injury if it results in a permanent impairment of at least 10% to the whole person, as assessed under the Motor Accident Guidelines. If the injury does not meet this threshold, the claimant may still be entitled to treatment and care benefits and weekly income payments, but not to damages for non-economic loss.
Role of SIRA Guidelines and Medical Evidence
The Safety and Insurance Regulatory Authority (SIRA) provides guidance on how medical evidence should be assessed in motor accident claims. SIRA’s Motor Accident Guidelines clarify that for a wrist fracture to be considered a threshold injury, the impairment must be objectively measurable and supported by clinical findings. This includes evidence of lasting functional loss, such as restricted movement, chronic pain, or reduced grip strength, even if imaging shows healing.
Insurers rely on independent medical assessments (IMAs) to determine whether a wrist fracture has resulted in a permanent impairment. These assessments are conducted by qualified medical practitioners and must follow the SIRA impairment rating schedule. If the IMA finds that the impairment is below 10%, the claimant will not be eligible for damages, even if they have experienced long-term symptoms.
Practical Steps to Support a Claim
To strengthen a claim for a wrist fracture, claimants should take the following steps. First, seek medical treatment promptly and keep all records, including doctor’s notes, imaging reports, and rehabilitation logs. Second, preserve any evidence from the accident, such as photographs of the vehicle damage, witness contact details, and a police report if one was filed. Third, notify the insurer as soon as possible, ideally within 28 days, to avoid delays in processing benefits.
Claimants should also keep a record of any income loss due to injury, including pay slips, employer letters, or tax returns. This information supports claims for weekly income payments. If the injury affects the ability to perform daily tasks, a functional capacity assessment may be required. Insurers may request a report from a treating medical practitioner or a rehabilitation specialist to assess ongoing impact.
Time Limits and Dispute Options
There are time limits that may affect a claim. While there is no strict deadline to make a claim, it is advisable to notify the insurer within 28 days of the accident. Delays may result in a delay in receiving benefits. If an insurer denies a claim or offers less than expected, the claimant may request a review. If unresolved, a dispute can be referred to the NSW Civil and Administrative Tribunal (NCAT) under the MAIA.
In Greater Sydney, claimants have access to SIRA’s free dispute resolution service, which helps mediate disagreements between claimants and insurers. This service is available at no cost and may resolve issues without formal proceedings. If a claim is not resolved through review or mediation, a formal application to NCAT may be necessary.
Hypothetical Example: A Wrist Fracture Claim in Sydney
A 38-year-old driver in Sydney was involved in a rear-end collision while stopped at a traffic light. The impact caused her to brace her hands against the steering wheel, resulting in a distal radius fracture. She sought treatment within 48 hours, received a cast, and underwent physiotherapy. After six months, she still experiences pain and limited wrist function. An independent medical assessment found a 12% whole person impairment due to the fracture.
Based on this evidence, her claim for treatment and care benefits, weekly income payments, and damages for pain and suffering would likely be supported under the MAIA. The insurer would assess her claim using the SIRA guidelines and may offer a settlement based on the impairment rating and loss of earnings.
Next Steps and When to Seek Advice
Every claim depends on its own facts. The outcome of a wrist fracture claim in NSW depends on the nature of the injury, the medical evidence, and the timing of treatment and notification. Insurers use SIRA’s guidelines to assess eligibility for benefits and damages, and decisions are based on objective medical assessment.
If you have sustained a wrist fracture in a motor accident in Greater Sydney, it is important to act promptly and preserve all relevant evidence. The available options may depend on the facts, evidence and applicable law. Complete the quick, no obligation enquiry form to request contact about your circumstances.