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Part 5 of the Motor Accident Guidelines: Minor injury (Soft tissue & minor psychological or psychiatric injuries)

Minor Injury

5.1 This Part of these Guidelines is made under the Motor Accident Injuries Act 2017 (NSW) (the Act), including sections 1.6(5), 3.28(3), 3.31 and 10.2 of the Act with respect to:

(a) assessing whether an injury caused by the motor accident is a minor injury for the purposes of the Act

(b) the approval of domestic services and home maintenance as appropriate treatment and care for soft tissue or minor psychological or psychiatric injury or injuries

(c) the authorisation of payment of statutory benefits for treatment and care expenses incurred more than 26 weeks after the motor accident for soft tissue or minor psychological or psychiatric injury or injuries.

5.2 Division 1.2, section 1.6 of the Act and Part 1, clause 4 of the Regulation provides the definition of a minor injury.

Assessment for soft tissue & minor psychological or psychiatric injuries

General provisions for assessment

5.3 The assessment will determine whether the injury related to the claim is a soft tissue injury or a minor psychological or psychiatric injury caused by the motor accident.

5.4 Diagnostic imaging is not considered necessary to assess minor injury.

5.5 A diagnosis for the purpose of a minor injury decision should be based on a clinical assessment by a medical practitioner or other suitably qualified person independent from the insurer.

5.6 The assessment of whether an injury caused by the accident is a minor injury for the purposes of the Act should be based on the evidence available and include all relevant findings derived from:

(a) a comprehensive accurate history, including pre-accident history and pre-existing conditions

(b) a review of all relevant records available at the assessment

(c) a comprehensive description of the injured person’s current symptoms

(d) a careful and thorough physical and/or psychological examination

(e) diagnostic tests available at the assessment. Imaging findings that are used to support the assessment should correspond with symptoms and findings on examination.

Soft tissue assessment – injury to a spinal nerve root

5.7 In assessing whether an injury to the neck or spine is a soft tissue injury, an assessment of whether or not radiculopathy is present is essential.

5.8 Radiculopathy means the impairment caused by dysfunction of a spinal nerve root or nerve roots when two or more of the following clinical signs are found on examination when they are assessed in accordance with ‘Part 6 of the Motor Accident Guidelines: Permanent impairment’.

(a) loss or asymmetry of reflexes (see the definitions of clinical findings in Table 6.8 in these Guidelines)

(b) positive sciatic nerve root tension signs(see the definitions of clinical findings in Table 6.8 in these Guidelines)

(c) muscle atrophy and/or decreased limb circumference (see the definitions of clinical findings in Table 6.8 in these Guidelines)

(d) muscle weakness that is anatomically localised to an appropriate spinal nerve root distribution

(e) reproducible sensory loss that is anatomically localised to an appropriate spinal nerve root distribution.

Minor psychological or psychiatric injury assessment

5.9 Where the neurological symptoms associated with the injured person’s injury of the neck or spine do not meet the assessment criteria for radiculopathy, the injury will be assessed as a minor injury.

5.10 In assessing whether an injury is a minor psychological or psychiatric injury, an assessment of whether a psychiatric illness is present is essential.

5.11 The assessment of whether a psychiatric illness is present must be made using the Diagnostic & Statistical Manual of Mental Disorders (DSM-5), Fifth Edition, 2013, published by the American Psychiatric Association.

5.12 Where the symptoms associated with the injured person’s psychological or psychiatric injury do not meet the assessment criteria for a recognised psychiatric illness, with the exception of acute stress disorder and adjustment disorder, the injury will be considered a minor injury.

Limits to domestic services and home maintenance

5.13 Domestic services and/or home maintenance may be approved as appropriate treatment and care for a person whose only injuries are minor injuries if the domestic service and/or home maintenance is all of the following:

(a) required as a result of injuries caused by the accident

(b) required because the person has reduced fitness for domestic tasks

(c) reasonable and necessary in the circumstances

(d) required for tasks the person used to do before the accident

(e) safe and effective

(f) a properly verified expense as set out in Part 4 of these Guidelines.

Table 5.1: Domestic services and home maintenance availability

Weeks post the accident

Available hours

1–4

Up to 12 hours in total over the 4 weeks

5–8

Up to 8 hours in total over the 4 weeks

9–26

Up to 6 hours in total over the 18 weeks

5.14 The domestic services and home maintenance limit of hours may be exceeded in agreement with the insurer where the injured person’s medical restrictions described in the certificate of fitness place a limit on the completion of pre-injury domestic tasks and responsibilities.

Treatment and care for minor injuries more than 26 weeks after the motor accident

5.15 The guidelines for claiming statutory benefits for treatment and care are found in ‘Part 4 of the Motor Accident Guidelines: Claims’.

5.16 For a person whose only injuries are minor injuries, the payment of treatment and care expenses incurred more than 26 weeks after the motor accident may be authorised if the treatment and care is:

(a) medical treatment, including pharmaceuticals

(b) dental treatment

(c) rehabilitation

(d) aids and appliances

(e) education and vocational training

(f) home and transport modifications

(g) workplace and educational facility modifications

and:

(h) the treatment and care will improve the recovery of the injured person, or

(i) the insurer delayed approval for the treatment and care expenses, or

(j) the treatment and care will improve the injured person’s capacity to return to work and/or usual activities.