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Pursuant to the Motor Accident Injuries Act 2017 (“the Act”), for the first 52 weeks after the accident, all persons (fault or not at fault) are entitled to make a claim for statutory benefits, meaning weekly benefits for wage loss payments and treatment and medical expenses.
However, the insurer is required to make a decision on liability for your claim for statutory benefits after the first 52 weeks after the accident, by considering the circumstances of the accident and your injury. The insurer is required to make this decision within nine (9) months after you have lodged the claim.
You are entitled to continue receiving statutory benefits payments after the first 52 weeks, only if you were not wholly or mostly at fault and you did not sustain a ‘threshold’ injury.
The Act (Section 1.6) defines threshold injury as:
– A soft tissue injury; and/or
– A psychological or psychiatric injury that is not a recognised psychiatric illness.
“A soft tissue injury is an injury to tissues that connects, supports or surrounds either structures or organs of the body, such as muscles, tendons, ligaments, menisci, cartilage, fascia, fibrous tissues, fat, blood muscles and synovial membranes, but not an injury to nerves or a complete or partial rupture of tendons, ligaments, menisci or cartilage. “
The Regulation further provides [Clause 4]:
– “An injury to a spinal nerve root that manifests in neurological signs (other than radiculopathy is included as a soft tissue injury for the purpose of the Act.”
– Each of the following injuries is included as a minor psychological or psychiatric injury for the purpose of the Act:-
a. Acute stress disorder; and
b. Adjustment disorder.
If you accept the insurer’s decision to dispute liability after 52 weeks, then your entitlement to statutory benefits will cease at the conclusion of the first 52 weeks.
If you disagree with the insurer’s decision, you may request the insurer to conduct an internal review, within 28 days from the date the liability notice was issued. It is important that you submit this request prior to the expiry of the 28 days, as this may have a detrimental effect on your claim.
The CTP scheme is a complex one and if you have sustained injuries (physical and/or psychological injuries) from a motor vehicle accident, we highly recommend you seek legal advice. The Head of our NSW team, Jessica Cheung is an Accredited Specialist in Personal Injury Law. Depending on your claim, we can review the liability notice on your behalf, request for an extension of time to lodge internal review, obtain medical evidence to support your injuries and position, and then challenge the insurer’s decision on your behalf.
If you believe you have sustained a personal injury and would like professional legal, reach out to Jessica and her team for a confidential discussion at no costs to you.