Changes to CTP Assessor Selection After 2017 Reforms
Where a person's only injuries resulting from the accident are threshold injuries, weekly benefits and treatment and care generally cease after 52 weeks (ss 3.11 and 3.28).
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).
Under the Motor Accident Injuries Act 2017, NSW CTP insurers now have clearer rules for selecting assessors to evaluate claims. Claimants on the Central Coast should understand how these reforms affect their ability to request a different assessor or challenge an assessment.
The 2017 reforms introduced specific procedures for insurers to select independent assessors, including requirements for transparency and documentation. Claimants may now request a reassessment if they believe the initial assessor’s findings are flawed or biased. This process is governed by the Motor Accident Guidelines, which outline standards for assessing injuries and determining compensation.
Practical Steps for Claimants on the Central Coast
If your CTP insurer has changed the assessor assigned to your claim, take these steps:
- Review the insurer’s notice: Insurers must provide reasons for changing assessors, including any concerns about the original assessor’s independence.
- Request a reassessment: You can formally ask for a new assessor by submitting a written request to the insurer, referencing the Motor Accident Guidelines.
- Gather evidence: Document any discrepancies in the original assessment, such as conflicting medical opinions or procedural errors.
- Seek independent medical advice: A second opinion from a registered medical practitioner may strengthen your case.
What Evidence Matters for Challenging an Assessor Change
To challenge an assessor change, claimants should focus on:
- Documentation of the original assessment: Include the assessor’s report, medical records, and any correspondence with the insurer.
- Insurer’s rationale: If the insurer claims the original assessor was ‘biased, ’ request evidence supporting this claim.
- Expert testimony: A medical professional’s opinion on the accuracy of the assessment can be critical.
- Compliance with guidelines: Ensure the new assessor follows the Motor Accident Guidelines for injury evaluation.
Time Limits and Dispute Options
CTP claims must be resolved within 52 weeks of the accident if only threshold injuries are involved (see s 4.4 of the Motor Accident Injuries Act 2017). If your claim exceeds this period, you may need to pursue a common law damages claim, which has different time limits.
If disputes arise, claimants can:
- Escalate to SIRA: The State Insurance Regulatory Authority (SIRA) oversees CTP insurers and can investigate complaints.
- Apply for a review: The NSW Civil and Administrative Tribunal (NCAT) can review assessment decisions if they are ‘not reasonable’ under the Act.
- Seek legal advice: A solicitor can help draft formal disputes or negotiate with insurers.
Example Scenario
A claimant on the Central Coast received a ‘threshold injury’ assessment but believes the assessor overlooked neurological signs. They request a reassessment, provide medical records showing spinal nerve-root involvement, and submit a second opinion from a neurologist. The insurer agrees to a new assessment, leading to a revised claim outcome.
When to Seek Legal Advice
CTP insurers may delay or deny reassessments, especially if the claim involves complex injuries or disputes over impairment ratings. A solicitor can help:
- Navigate the formal process for changing assessors.
- Challenge procedural errors by insurers.
- Prepare evidence for NCAT reviews or court action.
Next Steps
CTP entitlements depend on the accident date, injury type, and claim history. If you’re unsure how the 2017 reforms affect your case, complete the quick, no obligation enquiry form to request contact about your circumstances.