People who receive what is known as threshold injuries in motor vehicle accidents in NSW may receive benefits to aid their recovery for up to 52 weeks. However, as the RMB Compensation Law Division explains, you can challenge an insurer’s decision to stop your benefits when that period ends:
Under the Motor Accident Injuries Act 2017 (NSW), if you have been involved in a motor vehicle accident you may receive a liability notice from the Compulsory Third Party (CTP) Insurer on/or before 52 weeks notifying you that your statutory benefits are about to end.
This could be because you have been determined to have been mostly at fault for the accident, and/or because your injuries are considered “threshold injuries”.
Under the Motor Accident Injuries Act a threshold injury is considered a minor injury from which you are expected to recover well with treatment. Such an injury may be a soft tissue injury and/or particular psychological or psychiatric injuries.
A soft tissue injury is defined as an injury to tissue that connects, supports or surrounds other structures or organs of the body (such as muscles, tendons, ligaments, menisci, cartilage, fascia, fibrous tissues, fat, blood vessels and synovial membranes), but not an injury to nerves or a complete or partial rupture of tendons, ligaments, menisci or cartilage. Threshold injuries may include injuries such as whiplash and sprains.
Threshold psychological and psychiatric injuries, on the other hand, are generally changes in a person’s mood, such as feelings of guilt, sadness and anxiety.
Section 1.6(1)(b) of the Act defines such threshold injuries as “a psychological or psychiatric injury that is not a recognised psychiatric illness.” Adjustment disorder and acute stress disorder are two psychiatric illnesses which are classified as threshold injuries.
To challenge a decision made by an insurance company to end your benefits after 52 weeks, you must notify the insurer of your challenge within 28 days of the decision.
At RMB Lawyers, we can then assist you by reviewing and gathering the necessary medical evidence in relation to your injuries (including a medicolegal or treating doctor’s report).
The Insurer will then internally review its decision within 14 days of your request. If you are still not satisfied with the decision made by the insurer, we can help you refer your matter to the Personal Injury Commission for assessment.
Here at RMB, we have a wealth of experience and knowledge to assist you when insurers make adverse decisions, your first step should be to contact our office to arrange a free consultation. You can contact us by by phone or our 'Ask a Question' tool on our website.