Chest injury claim
Chest, rib and sternum injury after a motor accident
A seatbelt, steering wheel, airbag or vehicle impact can fracture ribs or the sternum and injure lungs, pleura, heart or chest-wall soft tissue. Treatment and incapacity may be substantial even where permanent WPI is zero. The Guidelines specifically state that uncomplicated healed rib and sternal fractures do not result in assessable impairment unless they leave permanent respiratory dysfunction.
Accident mechanism and diagnosis
How can this injury happen in a motor accident?
Seatbelt restraint
A high-force belt load can fracture ribs or sternum and cause pulmonary contusion or chest-wall bruising.
Steering wheel or dashboard impact
Direct anterior force may cause sternal fracture, flail segment, lung injury or cardiac trauma.
Motorcycle or pedestrian impact
Crush or road contact can cause multiple rib fractures, haemothorax, pneumothorax or diaphragmatic injury.
The injuries that may actually occur
- single or multiple rib fracture
- sternal fracture
- pulmonary contusion, pneumothorax or haemothorax
- flail chest or chest-wall deformity
- pleural scarring or diaphragmatic injury
- associated cardiac or vascular injury
Symptoms and functional effects to document
- acute pain with breathing, coughing or movement
- shortness of breath and reduced exercise tolerance
- sleep and lifting difficulty during healing
- persistent cough or chest tightness where lung injury remains
- work restriction caused by respiratory rather than pain-only limitation
Urgent health warning
Shortness of breath, low oxygen levels, coughing blood, fainting, worsening chest pain or signs of pneumothorax after a crash require urgent medical care.
Medical evidence
What tests and findings matter?
CT and X-rays establish the acute fractures and chest injury. Permanent impairment, if any, requires evidence of lasting respiratory function loss or another separately assessable organ injury.
| Test or record | What it can establish | What it cannot establish alone |
|---|---|---|
| Chest X-ray and CT | Shows fracture, displacement, lung contusion, pneumothorax, haemothorax and pleural injury. | A healed fracture visible on imaging does not by itself create assessable WPI. |
| Spirometry and gas transfer | Measures FVC, FEV1 and DCO where permanent respiratory impairment is suspected. | Pain-limited effort or poor test quality must be distinguished from lung dysfunction. |
| Exercise capacity testing | VO2 max may be relevant where resting lung tests do not explain claimed exertional loss. | Deconditioning, cardiac disease and musculoskeletal limits can also reduce exercise capacity. |
| Hospital and operative records | Document ventilation, drainage, thoracic surgery and complications that may explain long-term impairment. | Intensive acute care does not automatically mean permanent impairment remains. |
A separate legal classification
Threshold injury is not the same as WPI
A verified fracture or internal chest-organ injury is more than a simple soft tissue strain, but exact classification still follows the Act and evidence. Chest-wall bruising or strain without fracture or organ injury may be threshold. WPI is separately assessed after permanence.
A non-threshold classification does not set a WPI percentage. Conversely, a low or zero WPI assessment does not necessarily decide the threshold-injury classification. Physical and psychiatric WPI are assessed separately and cannot be combined to determine whether impairment is greater than 10%.
Motor Accident Guidelines Part 6
How is permanent impairment assessed?
Clauses 6.23 and 6.229 are explicit: uncomplicated healed rib and sternal fractures are not assessable. If the injury leaves permanent respiratory dysfunction, clauses 6.229-6.232 use AMA4 Chapter 5 Table 8, based on FVC, FEV1, DCO or VO2 max. A separate cardiac, scar or nerve injury uses its own method.
| Assessment issue | CTP method | Important limit |
|---|---|---|
| Healed rib or sternal fracture | Apply the non-assessable rule in clauses 6.23 and 6.229 where healing is uncomplicated and respiratory function is not permanently impaired. | Pain on palpation or a visible healed fracture does not override the express rule. |
| Permanent respiratory dysfunction | Use AMA4 Chapter 5 Table 8 under clauses 6.229-6.232. | The assessor must interpret test quality and other causes of reduced exercise capacity. |
| Separate chest-organ injury | Use the applicable cardiovascular, digestive, neurological or skin chapter. | Do not force every chest injury into the respiratory table. |
Verified Guidelines example or rule
Motor Accident Guidelines clauses 6.23 and 6.229 state that uncomplicated healed sternal and rib fractures do not result in assessable impairment unless they cause permanent impairment of respiratory function.
What may result in 0% or no assessable WPI?
- an uncomplicated healed rib fracture with normal respiratory function
- an uncomplicated healed sternal fracture with normal respiratory function
- resolved pneumothorax or contusion without permanent lung deficit
- ongoing pain without a separately assessable body-system impairment
What may support a higher assessment if verified?
- permanent abnormal FVC, FEV1 or DCO attributable to the crash injury
- supported loss of exercise capacity from respiratory dysfunction
- chest-wall deformity with permanent respiratory consequence
- a distinct cardiac, diaphragmatic, nerve or scar impairment assessed under its proper method
Combination and overlap rules
- Respiratory, cardiovascular and skin impairments use different methods and are combined only if distinct.
- Pain is included in the applicable body-system assessment and cannot receive a separate Chapter 15 allowance.
- Physical and psychiatric WPI remain separate for the greater-than-10% test.
What does not establish impairment by itself?
- a healed fracture on imaging
- persistent tenderness alone
- the number of ribs fractured
- breathlessness without valid respiratory testing and causal analysis
Crash-specific examples
Three rib fractures that heal
Treatment and time off work may be significant, but if respiratory function returns to normal the Guidelines say the healed fractures produce no assessable WPI.
Flail chest with persistent lung restriction
CT and surgery records establish the injury; valid pulmonary testing and respiratory opinion determine whether Table 8 applies permanently.
Claim file preparation
Evidence checklist
Assessment source
Chest and respiratory assessment under NSW CTP
Assessment source: Motor Accident Guidelines Part 6, clauses 6.23 and 6.229-6.232; AMA4 Chapter 5, Table 8 (page 162) only where permanent respiratory dysfunction exists.
Threshold injury: A fracture or internal organ injury may be non-threshold, but uncomplicated healed fracture can still have no assessable WPI.
What the assessor checks
- the express healed rib/sternum rule
- permanent respiratory function
- FVC, FEV1, DCO or VO2 max where applicable
- separate body-system consequences
What does not establish the result by itself
- fracture count
- pain alone
- healed imaging appearance
- unmeasured breathlessness
Official sources
Related NSW CTP guides
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Frequently asked questions
- Do healed rib fractures receive WPI?
- Not if they are uncomplicated and do not leave permanent respiratory dysfunction. Clauses 6.23 and 6.229 state this expressly.
- Can treatment still be covered if WPI is 0%?
- Potentially. Treatment benefits and permanent impairment are separate questions.
- What if I remain short of breath?
- The cause should be investigated with respiratory review and valid lung-function testing, including consideration of cardiac, pain and deconditioning factors.
- Does a pneumothorax automatically create WPI?
- No. A resolved pneumothorax may leave no permanent respiratory impairment.
- Can chest scarring be assessed?
- Potentially, under the skin method if it creates a distinct permanent impairment.