3. When will payment of weekly payments and medical expenses cease under the Statutory Benefits Scheme?
After you have claimed statutory benefits, the insurer will start paying weekly compensation payments and medical expenses if you cannot work for up to twelve months/52 weeks.
At around the nine month mark, the insurer will then make a decision about the following:
- Whether the motor vehicle accident was wholly or predominately your fault – or the fault of another driver; and
- Whether you have a “threshold injury” as defined by the Motor Accidents Injuries Act.
You are then entitled to continue to receive weekly payments after the initial 52 weeks, but only if the insurer decides that:
- The accident was not wholly or mostly your fault; and
- That you do not have a threshold injury.
A “minor injury” is defined as one or more of the following:
- A “soft tissue” injury;
- A “minor psychological or psychiatric” injury.
A soft tissue injury is defined as:
- “An injury to the 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 to tendon ligaments, menisci or cartilage.”
The Motor Accident Regulations add the following:
- “An injury to a spinal or nerve root that manifests in neurological signs (other than radiculopathy) is included as a soft tissue injury for the purposes of the Act.”
A minor psychological or psychiatric injury is defined as:
- “A psychological or psychiatric injury that is not a recognised psychiatric illness.”
A whiplash-type injury to your neck or back is considered a soft tissue injury. However, if you have any tendon damage, ligament damage, scarring, head injury, neurological injury or similar, this is a “non-minor” injury.
When it comes to a psychological injury, an adjustment disorder (ie. an emotional or behavioural reaction to a stressful event or change in a person’s life) is not recognised as a psychological illness. That means you would need to demonstrate that you have PTSD from the motor vehicle accident to prove that your injury is non-minor.
It is the insurer that decides whether you have a minor injury, a major injury, or none at all. If you disagree with the insurance company’s decision, you should immediately contact an accredited specialist in personal injury law. That lawyer will be able to help you determine if your injuries are minor or non-minor and help you make an application to the Personal Injury Commission to challenge the insurer’s decision.