If you have been injured in a motor vehicle accident, medical assessments are likely to play an important role in your claim. These assessments help determine the nature and extent of your injuries, the treatment you require, and the compensation and benefits you may be entitled to receive.
In NSW, disputes about injuries and treatment can arise at various stages of a claim. Insurers may rely on their own medical experts, while injured persons may obtain reports from their treating practitioners or independent Specialists. Where there is a disagreement, the matter can be referred to the Personal Injury Commission (PIC) for determination by a Medical Assessor.
What Types of Medical Issues Can Be Assessed?
Medical Assessors at the PIC may be asked to determine a range of issues, including:
- Whether an injury is a threshold injury;
- Whether the injuries were caused by the motor vehicle accident;
- The degree of permanent impairment resulting from the accident;
- Whether treatment and rehabilitation expenses are reasonable and necessary;
- Whether an injured person has a work capacity resulting from their injuries.
These determinations can have a significant impact on a person's entitlement to ongoing statutory benefits and common law damages.
Threshold Injury Assessments
One of the most common disputes in NSW motor accident claims relates to whether an injury is classified as a threshold injury.
Under the Motor Accident Injuries Act 2017, a finding that your injuries are threshold injuries can significantly affect your entitlements. In most cases, statutory benefits will cease after 52 weeks, and you will not be entitled to pursue a claim for damages. Given the importance of this issue, medical examinations are often arranged to assess the nature of the injuries, and disputes may ultimately be referred to the Personal Injury Commission (PIC) for determination.
A Medical Assessor will review the available evidence, which can include medical records, imaging, specialist reports and submissions from the parties, before issuing a decision.
Permanent Impairment Assessments
Where you have sustained more serious injuries, an assessment of permanent impairment may be required.
Permanent impairment assessments consider the long-term impact of the injuries and are conducted in accordance with the relevant guidelines. These assessments can be particularly important when determining eligibility to pursue damages for non-economic loss.
Medical Assessors may examine you, review your medical history and consider expert evidence before reaching a conclusion regarding the level of impairment.
Treatment and Causation Disputes
Disputes can also arise regarding whether proposed treatment is reasonable and necessary, or whether certain symptoms and conditions have been caused by the accident.
For example, an insurer may dispute funding for surgery, physiotherapy, psychology treatment or other ongoing care. In these circumstances, the PIC may be asked to determine whether the treatment is appropriate and whether it relates to the injuries sustained in the accident.
Preparing for a Medical Assessment
If you are required to attend a medical assessment, it is important to:
- Arrive on time and cooperate with the assessment process;
- Be honest and accurate when describing your symptoms;
- Explain how your injuries affect your daily activities, employment and quality of life; and
- Provide a complete medical history when requested.
The outcome of a medical assessment may significantly affect the progress and value of your claim.
How Walker Law Group Can Help
Medical disputes can be complex and often involve competing medical opinions. Understanding the assessment process and ensuring the appropriate evidence is available can make a significant difference to the outcome of your claim.
At Walker Law Group, we regularly assist clients in navigating medical disputes before the Personal Injury Commission and advocating for their rights throughout the claims process.
If you have questions about a medical assessment or a motor accident claim, contact our team to discuss your options and obtain tailored legal advice.
