Changes to CTP Assessor Processes After 2017 Reforms
The 2017 reforms to NSW’s Motor Accident Injuries Act introduced significant changes to how insurers select and manage claims assessors, particularly in regional areas like Newcastle and Hunter. These changes affect injured claimants by altering the rules for challenging assessor decisions and streamlining the process for requesting a different assessor. Key updates include:
- Greater transparency in assessor selection: Insurers must now provide clearer reasons for choosing a specific assessor, reducing ambiguity about how assessments are conducted.
- Expanded claimant rights to challenge decisions: Injured people can now request a review of an assessor’s findings more easily, with specific procedures outlined in SIRA guidelines.
- Standardised dispute resolution processes: A formal pathway was created for resolving disagreements between claimants and insurers, ensuring consistency across NSW.
Practical Steps for Claimants Disagreeing with an Assessor
If you disagree with a CTP insurer’s choice of assessor or their findings, take these steps:
- Request a review: Contact the insurer in writing to formally ask for a reassessment of your claim. SIRA’s guidelines outline the required format for such requests.
- Provide evidence: Support your case with medical records, accident reports, and any other documentation showing the injury’s impact. For example, if a claimant in Newcastle disputes a low impairment rating, detailed medical notes from a specialist are critical.
- Follow the dispute process: If the insurer refuses to review the assessment, escalate the matter through the formal dispute resolution pathway outlined in the Motor Accident Injuries Act 2017.
Time Limits and Legal Boundaries
Claimants must act within strict timeframes. Under the Act, you generally have five years from the accident date to challenge an assessor’s decision, but this can vary depending on the type of claim. Delays in requesting a review may jeopardise your ability to contest the assessment.
The reforms also clarify that insurers cannot unreasonably delay assessments. If an assessor’s report is incomplete or inconsistent with medical evidence, claimants can request a new assessment under the updated rules.
Example: A Claimant in Newcastle Challenges an Assessor’s Decision
Consider a scenario where a cyclist in Newcastle suffers a soft-tissue injury and is assessed by an assessor who rates their impairment at 10%. The claimant’s doctor provides evidence of ongoing pain and reduced mobility, arguing the rating is too low. Under the 2017 reforms, the claimant can formally request a reassessment, citing the discrepancy between the medical evidence and the assessor’s conclusion. The insurer must then either provide a revised assessment or justify its original decision.
When to Seek Legal Advice
While the reforms improved claimant rights, navigating the assessor dispute process can be complex. Legal advice is recommended if:
- The insurer refuses to provide a review
- The claimant’s injuries are severe or long-term
- There are disputes over the application of the Motor Accident Guidelines
Next Steps
The 2017 reforms have changed how CTP insurers operate in Newcastle and Hunter, but the specifics of your case will determine the best course of action. For tailored guidance, complete the quick, no obligation enquiry form to discuss your circumstances.