Wrist Fractures and CTP Claims in NSW
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 from a motor vehicle accident in Ballina, you may be eligible for compensation through NSW's Compulsory Third Party (CTP) scheme. The scheme covers treatment costs, rehabilitation, and income support for injuries caused by motor accidents. This article explains how to document your claim, what evidence is needed, and how SIRA assesses rehabilitation for wrist injuries.
Key CTP Rules for Wrist Fractures
Under the Motor Accident Injuries Act 2017, CTP insurers must cover treatment and rehabilitation for injuries caused by motor accidents. For wrist fractures, this includes:
- Surgical procedures and medical imaging
- Physiotherapy and occupational therapy
- Equipment like splints or braces
- Income support if you can't work
SIRA (State Insurance Regulatory Authority) manages these claims. They require detailed medical documentation to assess the injury's impact on your ability to work and daily activities. A wrist fracture may qualify for benefits if it meets the 'threshold injury' definition under the Motor Accident Guidelines, which includes fractures requiring surgical repair or significant functional limitation.
Evidence Needed for Rehabilitation Planning
To support your claim, you must provide:
- Medical records: MRI/CT scans, X-rays, and surgeon notes confirming the fracture
- Treatment plan: Details of surgery, physiotherapy, and any prescribed rehabilitation
- Occupational therapy reports: Assessments of how the injury affects work capacity
- Income records: Proof of lost wages or reduced earning capacity
- Communication with insurers: All correspondence with SIRA or your insurer
For example, if your wrist fracture requires 12 weeks of physiotherapy, your doctor must document how this impacts your ability to work. SIRA will assess whether the treatment is 'reasonably necessary' under the Motor Accident Guidelines.
Time Limits and Dispute Resolution
You must notify your insurer within 52 weeks of the accident. After this period, benefits for 'threshold injuries' (like wrist fractures) are generally limited, though long-term rehabilitation may still be considered. If your claim is disputed, SIRA will review it based on medical evidence. You may need to request a review of their decision or seek legal advice if the insurer refuses to pay.
When to Seek Legal Advice
CTP claims can be complex, especially when injuries require prolonged rehabilitation. A lawyer can help you:
- Ensure all medical records are submitted correctly
- Challenge decisions to limit benefits
- Navigate SIRA's assessment process
If your wrist fracture has caused ongoing pain or mobility issues, it's important to act promptly to preserve your right to claim compensation.
Next Steps
CTP claims depend on the accident date, injury severity, and evidence submitted. To request contact about your circumstances, complete the quick, no obligation enquiry form.