How CTP Insurers Can Change Assessors in NSW After 2017 Reforms
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).
The 2017 reforms to New South Wales’ Compulsory Third Party (CTP) motor accident compensation scheme introduced significant changes to how insurers handle disputes over claims assessors. These changes, effective from 1 January 2018, altered the rules for replacing assessors and introduced stricter procedural requirements. Claimants in Newcastle and Hunter must understand these changes to protect their rights.
Key Changes to Assessor Replacement Rules
Before 2017, insurers could replace an assessor without clear legal limits. The reforms now require insurers to have a valid reason for changing an assessor, such as a conflict of interest or failure to meet professional standards. Under the Motor Accident Injuries Act 2017, insurers must notify claimants in writing of any assessor change and provide a detailed explanation.
A critical change is the requirement for insurers to justify any replacement of an assessor. If an insurer replaces an assessor without a valid reason, the claimant may challenge the decision. This aligns with the scheme’s goal of ensuring fair and transparent claims processes.
Practical Steps for Claimants in Newcastle and Hunter
If your CTP insurer attempts to change your assessor, take these steps:
- Request written notice of the change, including the reason for the replacement.
- Review the insurer’s justification against the Motor Accident Injuries Act 2017 and SIRA guidelines.
- Seek independent medical opinion if the new assessor’s report conflicts with your treatment records.
- Document all correspondence with the insurer, including dates and details of any assessor changes.
Claimants should also preserve evidence such as medical records, accident reports, and witness statements. These documents are crucial if disputes escalate to a review by the NSW Civil and Administrative Tribunal (NCAT).
Time Limits and Dispute Resolution
Insurers must act within the 52-week statutory benefit period for threshold injuries. If a claimant’s injury falls outside this threshold, the insurer may reassess the claim under the full damages regime. However, any assessor change must occur within the legal time limits outlined in the Motor Accident Injuries Regulation 2017.
Disputes over assessor changes can be resolved through NCAT. Claimants should seek legal advice if the insurer’s actions appear to delay or prejudice their claim. The 2017 reforms emphasize that insurers must act in good faith, and claimants have the right to challenge decisions that breach this principle.
Example: A Claimant’s Experience
Consider a claimant in Newcastle who sustained a soft-tissue injury. Their initial assessor, a registered physiotherapist, recommended a 12-week recovery. The insurer later replaced the assessor with a different professional, citing ‘inconsistencies’ in the report. The claimant challenged the change, arguing the new assessor had not reviewed their full medical history. NCAT ruled in the claimant’s favor, emphasizing that insurers must provide a clear, documented justification for any assessor replacement.
When to Seek Legal Advice
Claimants should consult a legal professional if:
- The insurer’s assessor change appears arbitrary or unexplained.
- The new assessor’s report conflicts with medical evidence.
- The insurer delays or refuses to provide a written explanation.
- The claimant’s injury may fall outside the threshold injury definition.
Next Steps
CTP entitlements depend on the accident date, injury type, and claim history. If you’re in Newcastle or Hunter and your insurer has changed your assessor, seek guidance to understand your options. Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.