A threshold injury under the Motor Accident Injuries Act 2017 (NSW) includes a soft tissue injury and a psychological or psychiatric injury that is not a recognised psychiatric illness (adjustment disorder and acute stress disorder are the usual examples; s 1.6 and Motor Accident Guidelines Part 5).
If you're disputing the amount or type of attendant care services approved under your NSW Compulsory Third Party (CTP) claim, understanding the resolution process is critical. SIRA (State Insurance Regulatory Authority) manages CTP claims, and disputes over care services typically involve reviewing medical evidence, care plans, and compliance with the Motor Accident Guidelines. This article explains how to resolve conflicts over attendant care entitlements, including internal review options, mediation, and when to seek legal advice.
How SIRA Handles Disputes Over Attendant Care Services
SIRA evaluates claims based on medical evidence and the severity of injuries. For disputes over attendant care services, claimants should first submit a written request for a review of the decision. SIRA will reassess the claim by:
- Re-evaluating medical records and care plans
- Checking whether the care services meet the 'threshold injury' criteria under the Motor Accident Injuries Act 2017
- Confirming that the care plan aligns with the Motor Accident Guidelines
If you disagree with SIRA's decision, you may request an internal review within 28 days of receiving the notice. This process allows SIRA to reconsider the claim based on new evidence or a reassessment of existing records.
Dispute Resolution Options in Auburn
In Auburn, as in other NSW locations, disputes over attendant care services can be resolved through:
- Internal review: SIRA will reassess the claim without requiring external mediation.
- Mediation: If the dispute involves complex medical or financial issues, SIRA may refer the matter to a neutral mediator.
- Legal review: If SIRA's decision is unsatisfactory, you may seek legal advice to challenge the decision through the NSW Civil and Administrative Tribunal (NCAT) or the Supreme Court.
It's important to note that SIRA's decisions are binding unless overturned through formal legal channels. Claimants should act quickly, as time limits apply to dispute resolution processes.
Practical Steps for Resolving Disputes
To resolve a dispute over attendant care services, claimants should:
- Gather all medical records, care plans, and correspondence with SIRA
- Document the specific disagreement (e.g., disagreement over hours of care or service type)
- Submit a written request for review within the required timeframe
- Seek independent medical opinions if the dispute involves injury severity
- Consider legal advice if the dispute escalates to a formal challenge
Evidence such as a doctor's report confirming the need for attendant care, or a care provider's log of services, can strengthen your case. SIRA may also request additional evidence if the initial claim was based on incomplete information.
Time Limits and When to Seek Advice
SIRA typically has 28 days to respond to a written review request. If you disagree with the outcome, you must act within 28 days of receiving the decision to request an internal review. For disputes that escalate beyond SIRA's authority, legal action must be initiated within 6 months of the decision date under the Civil Procedure Act 2005.
If you're unsure whether your dispute falls within SIRA's jurisdiction or need help preparing evidence, it's essential to seek legal advice. A solicitor can help you understand your options and ensure your claim meets all legal requirements.
Example of a Common Dispute
Consider a scenario where a claimant receives a decision limiting attendant care services to 2 hours per day, but their medical records show a need for 4 hours. In such cases, the claimant should:
- Submit a written request for review, highlighting the discrepancy
- Provide updated medical evidence supporting the 4-hour requirement
- Await SIRA's reassessment of the claim
This example illustrates how disputes often hinge on the interpretation of medical evidence and the alignment of care plans with SIRA's guidelines.
Next Steps
Disputes over attendant care services can be complex, but understanding SIRA's processes and gathering strong evidence can help resolve conflicts. If you're in Auburn and need assistance with your CTP claim, consider completing the quick, no obligation enquiry form to request contact about your circumstances.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.