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).
Wrist fractures from motor accidents can lead to significant compensation claims under NSW's Compulsory Third Party (CTP) scheme. However, injured road users often make errors that jeopardise their entitlements. This article explains how to avoid common mistakes when claiming for wrist fractures, including proper documentation, understanding SIRA requirements, and timing.
Understanding SIRA's Role in Wrist Fracture Claims
The State Insurance Regulatory Authority (SIRA) administers NSW's CTP scheme, which provides benefits for injuries caused by motor vehicle accidents. Wrist fractures fall under the 'threshold injury' category if they meet specific medical criteria outlined in the Motor Accident Guidelines. SIRA assesses claims based on the nature of the injury, not fault, meaning drivers, passengers, pedestrians, and cyclists may qualify regardless of who caused the collision.
A critical mistake is assuming all wrist fractures automatically qualify. SIRA requires medical evidence confirming the injury meets the threshold definition. For example, a wrist fracture must produce neurological signs beyond radiculopathy (nerve-related pain radiating down the arm) to qualify as a threshold injury. Failing to obtain this documentation can result in a claim being denied or limited to statutory benefits.
Key Evidence to Avoid Common Errors
Successful CTP claims depend on thorough documentation. Injured individuals must gather:
- Medical records showing the fracture's diagnosis, treatment, and recovery timeline
- Accident reports from police or insurance companies
- Witness statements and photographs of the scene
- Income records to support claims for lost wages
- Correspondence with insurers detailing the injury's impact
A common error is delaying medical attention. SIRA requires prompt treatment to establish a clear link between the accident and the injury. Delayed care may lead to disputes over causation, especially if the fracture is not immediately apparent.
Time Limits and Dispute Resolution
CTP claims must be submitted within 52 weeks of the accident, though extensions may apply in exceptional circumstances. After 52 weeks, weekly income payments and treatment benefits typically stop unless the injury is classified as a 'whole person impairment' (a permanent, life-altering condition). This distinction is crucial: threshold injuries (including wrist fractures) generally do not qualify for ongoing damages, while severe impairments may entitle claimants to additional compensation.
Disputes often arise when claimants fail to challenge SIRA's assessment. If an insurer rejects a claim, injured individuals should:
- Request a written explanation of the decision
- Seek independent medical opinions to dispute the injury's classification
- Lodge a formal objection with SIRA within the prescribed timeframe
When to Seek Legal Advice
While SIRA provides a structured claims process, navigating disputes or complex injuries may require legal assistance. A solicitor can help interpret SIRA guidelines, challenge incorrect classifications, or negotiate for additional benefits. However, legal advice should not be sought solely for minor claims, as CTP entitlements are typically limited to statutory benefits rather than common law damages.
Final Steps for Claimants
To avoid pitfalls, injured road users should:
- Act promptly to seek medical care and document the injury
- Submit claims within 52 weeks (or apply for an extension)
- Avoid making statements that could imply fault
- Consult a legal professional if the injury exceeds threshold criteria
CTP claims involving wrist fractures require careful attention to medical evidence and statutory deadlines. By understanding SIRA's requirements and avoiding common mistakes, claimants can maximise their entitlements under NSW law.
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