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).
If you're a caregiver or family member in Bathurst NSW dealing with a CTP insurer's decision to change assessors, you have legal rights and practical steps to consider. Under NSW law, SIRA (State Insurance Regulatory Authority) oversees CTP claims, including assessor changes. This article explains how caregivers and families can navigate assessor changes, what documentation matters, and when to seek legal advice.
NSW CTP Rules Governing Assessor Changes
Under the Motor Accident Injuries Act 2017, CTP insurers must provide a fair and reasonable assessment of claims. If an insurer changes the assessor for your claim, SIRA has specific processes to ensure the change is justified. For claims involving caregivers, the assessor must consider how the injury impacts your ability to care for dependents. SIRA guidelines state that any assessor change must be documented in writing and provide a clear reason, such as a conflict of interest or lack of expertise.
Caregivers have the right to request a review of the assessor change decision. SIRA requires insurers to consider the 'whole person' impact of injuries, including how they affect family responsibilities. If the change affects compensation calculations for caregiver-dependent claims, the insurer must justify how the new assessor's evaluation aligns with the Motor Accident Guidelines.
Practical Steps and Evidence for Families
When disputing an assessor change, families should gather evidence showing the original assessor's evaluation included caregiver-related impacts. Key documents include:
- Medical reports linking the injury to caregiving limitations
- Witness statements from family members about care needs
- Previous correspondence with the insurer about the claim's scope
- SIRA's 'What you can claim' guidelines, which include caregiver support payments
Families should also request a written explanation of why the assessor change occurred. SIRA requires insurers to provide this within 14 days of the change. If the insurer fails to respond adequately, families may need to escalate the matter to SIRA.
Time Limits and Dispute Options
CTP insurers must act within 52 weeks of the accident for claims involving threshold injuries. If the assessor change delays your claim beyond this period, it could affect your right to weekly benefits or treatment payments. Families should note that disputes over assessor changes must be resolved within 28 days of receiving the insurer's decision, per SIRA's dispute resolution protocols.
If the insurer refuses to reconsider the assessor change, families can apply to SIRA for a review. SIRA may appoint an independent assessor to evaluate whether the change was justified. This process is outlined in SIRA's 'Making a motor accident claim' guidelines, which emphasize that caregivers' needs are a critical factor in determining claim outcomes.
When to Seek Legal Advice
While SIRA provides clear processes, families often need legal guidance to ensure their rights are protected. A solicitor can help challenge an insurer's decision if the assessor change:
- Fails to consider your caregiving responsibilities
- Delays compensation beyond the 52-week threshold
- Disregards SIRA's 'whole person' assessment requirements
Legal advice is particularly important if the assessor change impacts your ability to receive caregiver support payments or if the insurer disputes the need for ongoing family care documentation.
Example Scenario
Consider a case where a car accident leaves a primary caregiver with a soft-tissue injury. The original assessor included caregiver support payments in the claim. The insurer then changes assessors, arguing the injury doesn't meet the 'threshold injury' definition. The family must prove the injury's impact on caregiving, using medical evidence and SIRA's guidelines to challenge the change.
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.