Wrist Fractures and the PIC's Expectations in Disputes
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).
If you've suffered a wrist fracture in a motor accident in NSW, understanding what the Prescribed Injury Claimant (PIC) expects during disputes is critical. The PIC assesses claims under the Motor Accident Injuries Act 2017 (MAIA) and SIRA guidelines. This article explains what evidence matters, how SIRA evaluates wrist fractures, and steps to resolve disputes in Ashfield.
Key NSW CTP Rules for Wrist Fractures
Under the MAIA, wrist fractures may qualify as 'threshold injuries' if they meet specific medical criteria. SIRA's guidelines define threshold injuries as those requiring treatment and producing neurological signs, such as nerve-root damage. For example, a wrist fracture with associated nerve injury that affects hand function may be classified as a threshold injury. However, if the fracture is isolated and does not meet these criteria, it may not qualify for statutory benefits under the MAIA.
The PIC expects claimants to provide medical evidence confirming the injury's nature and impact. This includes:
- A detailed medical report from a registered medical practitioner
- Imaging (e.g., X-rays, MRI) showing the fracture
- Documentation of treatment received
- Evidence of how the injury affects daily activities
Evidence and Dispute Resolution Steps
When disputes arise over wrist fractures, the PIC typically requires:
- A clear link between the fracture and the motor accident
- Proof that the injury meets the threshold injury definition
- Evidence of ongoing impact on the claimant's ability to work or perform daily tasks
To resolve disputes, claimants should:
- Seek a second medical opinion if the injury's severity is contested.
- Submit all relevant medical records to the PIC within 52 weeks of the accident (the statutory limit for benefits).
- Request a review through SIRA's internal review process, which allows for re-evaluation of claims.
SIRA's Approach to Wrist Fractures
SIRA assesses wrist fractures based on the Motor Accident Guidelines. For example, a fracture with minimal displacement and no neurological signs may not qualify for statutory benefits, but could still be considered for common law damages if it results in long-term impairment. The PIC may also consider the claimant's pre-accident occupation and how the fracture affects their capacity to work.
A hypothetical example: A cyclist with a wrist fracture from a collision may dispute the PIC's classification of the injury as non-threshold. If the fracture causes chronic pain and limits hand function, the claimant could argue for a higher impairment rating under the MAIA's whole person impairment guidelines.
Time Limits and When to Seek Advice
Statutory benefits under the MAIA are generally limited to 52 weeks after the accident if the injury is classified as a threshold injury. If the claimant's only injuries are threshold injuries, benefits may stop after this period. However, if the injury results in long-term impairment, the claimant may still pursue common law damages.
Disputes over wrist fractures should be resolved within 52 weeks to avoid losing statutory benefits. If the PIC rejects a claim, claimants should seek legal advice promptly to explore options such as internal reviews, mediation, or disputing the injury classification.
Next Steps
CTP claims involving wrist fractures depend on the accident date, injury severity, and evidence provided. To request contact about your circumstances, complete the quick, no obligation enquiry form.