Changes to Assessor Selection After the 2017 Reforms
Under the Motor Accident Injuries Act 2017 (MAIA), NSW CTP insurers now have clearer rules for selecting assessors to evaluate claims. The 2017 reforms introduced greater transparency and specific criteria for choosing assessors, particularly impacting claimants in Greater Sydney. Insurers must now follow a structured process to select assessors, ensuring fairness and consistency in claim assessments.
How the New Process Works
The reforms require CTP insurers to:
- Provide claimants with details about the assessor’s qualifications and experience
- Allow claimants to request a different assessor if they believe the current one is unsuitable
- Document the reasoning for assessor selection in written correspondence
These changes aim to reduce disputes over assessor impartiality and ensure claimants understand the evaluation process. For example, a claimant in Sydney may now challenge an assessor’s suitability based on their expertise in spinal injuries, a key factor in threshold injury claims.
Practical Steps for Claimants
- Request Assessor Details: Insurers must provide information about the assessor’s credentials. If this information is unclear, claimants should ask for written clarification.
- Submit a Change Request: If the assessor’s suitability is in question, claimants can formally request a replacement. This should be done in writing and include specific concerns (e.g., lack of experience with soft tissue injuries).
- Keep Records: Document all communications with insurers, including dates, assessor details, and any disputes. This evidence may be needed if a dispute arises.
Time Limits and Dispute Options
Claimants must notify insurers of assessor concerns within 28 days of receiving the initial assessment details (per SIRA guidelines). If disputes persist, claimants can:
- Lodge a formal complaint with the NSW Civil and Administrative Tribunal (NCAT)
- Seek independent legal advice to explore further options
Legal Boundaries
The MAIA does not explicitly outline assessor selection rules, so insurers rely on SIRA’s guidelines. Claimants cannot demand a specific assessor but can challenge the selection process if it violates principles of fairness or transparency. For instance, an insurer cannot arbitrarily assign an assessor with a history of dismissing threshold injury claims.
A Real-World Example
Consider a claimant in Sydney who sustained a soft tissue injury. The insurer assigned an assessor with no spinal injury expertise. The claimant requested a replacement, citing the assessor’s lack of relevant experience. The insurer then provided a new assessor with spinal injury assessment credentials, aligning with the 2017 reforms’ emphasis on suitability.
When to Seek Advice
If disputes over assessor selection delay claims or affect compensation, claimants should consult a solicitor. Legal advice can help navigate complex procedures, such as challenging an insurer’s refusal to replace an assessor.
Next Steps
CTP entitlements depend on the accident date, injury type, and claim history. To request contact about your circumstances, complete the quick, no obligation enquiry form.