When Can a CTP Insurer Replace an Assessor?
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 NSW law, a CTP insurer may replace an assessor if they believe the original assessor’s report is incomplete, inaccurate, or fails to reflect the claimant’s full needs. This decision must align with the
- Motor Accident Injuries Act 2017* and
- SIRA guidelines*, which emphasize fairness and transparency. Insurers cannot arbitrarily change assessors; they must have a legitimate reason tied to the claim’s evidence.
How Assessor Changes Impact Caregivers and Families
A new assessor may reassess the claimant’s injury severity, care requirements, or ability to perform daily tasks. This can directly affect caregiver responsibilities, such as adjusting care plans or proving the necessity of support. Families should be aware that changes may lead to:
- Re-evaluation of care hours or types of assistance needed
- Adjustments to weekly income payments or treatment benefits
- Potential delays in securing consistent support arrangements
Steps to Challenge Unfair Assessor Changes
Families can challenge an insurer’s decision by:
- Requesting a written explanation of why the assessor was replaced
- Providing additional evidence like medical records, care logs, or witness statements
- Appealing through SIRA if the insurer refuses to reconsider
SIRA’s What You Can Claim page outlines how to dispute decisions, emphasizing that claimants must demonstrate the change impacts their care needs or financial support.
Critical Documentation for Disputes
To support your case, gather:
- Medical reports detailing injury severity and care requirements
- Caregiver logs showing hours, tasks, and the claimant’s dependency
- Income records to prove financial impact of changed benefits
- Correspondence with the insurer about the assessor change
These documents help establish whether the new assessment aligns with the claimant’s actual needs.
Time Limits and When to Seek Advice
CTP claims have strict time limits. For example, weekly benefits typically stop after 52 weeks unless the injury meets the threshold injury criteria. If an assessor change affects your entitlements, seek legal advice promptly. Delays can jeopardize access to care payments or lifetime support.
A Hypothetical Example
Imagine a claimant in Ballina requiring 20 hours of weekly caregiving. An insurer replaces the assessor, reducing the approved hours to 10. The family must prove the original assessment was accurate, using medical evidence and care records. This scenario highlights how assessor changes can directly affect support arrangements.
Next Steps
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.