Understanding CTP Assessor Changes in NSW
If you are managing a motor accident claim in New South Wales and your insurer has changed your claims assessor or case manager, you may be concerned about how this affects your care, support and claim progress. In NSW, the Motor Accident Injuries Act 2017 (MAIA) governs Compulsory Third Party (CTP) insurance claims, and insurers are permitted to change assessors during a claim. This change does not alter your rights under the law, but it may impact how your claim is managed, particularly if you or a family member rely on ongoing care or support.
The change of assessor is not a decision made by you, but by the insurer, usually in response to operational needs, a change in your medical or functional status, or a review of claim complexity. The insurer must notify you of the change and provide a new contact point. You have the right to request a review of the change if you believe it negatively affects your claim management, especially where caregiving responsibilities or family needs are involved.
How Caregiver and Family Factors Influence CTP Claims
The Motor Accident Injuries Act 2017 and SIRA’s guidance acknowledge that a claimant’s personal circumstances, including caregiving roles and family support needs, are relevant to the assessment of injury and claim progress. If you are a primary caregiver for a child, elderly relative, or another family member with a disability, your injury may impact your ability to provide care, and this can be considered when assessing your claim.
SIRA’s guidance on making a motor accident claim notes that claimants should inform their insurer of any changes in their personal circumstances, including caregiving responsibilities, as these may affect the need for treatment, care, and financial support. For example, if you were the main provider of daily care for a dependent and your injury limits your capacity to assist, this may justify additional treatment and care benefits under the CTP scheme.
The scheme allows for the assessment of care needs as part of the claim, including the cost of formal or informal care. If you are unable to perform household tasks, supervise children, or assist a dependent due to injury, you may be eligible for care and support benefits. These benefits are not automatic but must be supported by medical evidence and a care plan.
Steps to Take When Your Assessor Changes
If your CTP insurer changes your assessor, you should take the following steps to protect your claim and ensure your family’s needs are properly addressed:
- Notify the insurer in writing of any changes in your care responsibilities, including who now provides care and how this affects your daily life.
- Request a copy of the new assessor’s contact details and confirm their role in your claim.
- Provide updated medical evidence, including a report from your treating medical practitioner, if your injury has changed or if your care needs have increased.
- Keep records of all communications with the insurer and new assessor, including dates, names, and summary of discussions.
- If you believe the change in assessor has caused delays or poor communication, you may request a review of the decision to change.
SIRA’s guidance on making a claim states that claimants have the right to expect clear, timely, and respectful communication from their insurer. If you experience a breakdown in communication or feel your claim is not being managed fairly, you can raise a formal complaint with the insurer and, if unresolved, contact SIRA for assistance.
Time Limits and Dispute Options
There is no fixed time limit for requesting a change of assessor, but delays in notifying the insurer of changes in your care situation may affect the timing of benefit payments. You must still meet the statutory deadlines for making a claim, which are generally two years from the date of the motor accident.
If you believe the change of assessor has caused a delay in processing your claim, particularly where caregiving responsibilities are involved, you may seek a review. SIRA provides a process for reviewing decisions made by CTP insurers, including decisions about claim management and assessor assignment. You can apply to SIRA for a review if you believe the insurer has failed to act in a timely or fair manner.
A hypothetical example: A mother who was the primary caregiver for her disabled child sustained a back injury in a motor accident. After six months, her insurer changed her assessor. During the transition, her application for care and support benefits was delayed. She provided updated medical evidence and a care plan from her specialist, and formally requested a review of the delay. SIRA later confirmed that the insurer had not met its duty to manage the claim with due regard to her family’s needs, and the claim was reinstated with backdated benefits.
When to Seek Independent Advice
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.