Understanding Assessor Changes in NSW CTP Claims
If you or a family member has been involved in a motor accident in Greater Sydney and your CTP insurer has changed your claims assessor or case manager, you may be concerned about how this affects your claim and your family's support. A change of assessor is not uncommon and may occur for reasons including internal insurer review, workload management, or a need for specialist assessment. However, such changes can disrupt communication, delay treatment coordination, and impact the support available to caregivers, particularly when the injured person is a child, elderly, or has ongoing care needs.
The Motor Accident Injuries Act 2017 (MAIA) governs CTP claims in New South Wales. Under this law, the insurer is responsible for appointing and managing the claims assessor who oversees your claim, including arranging medical assessments, approving treatment, and assessing your entitlements to benefits. While you do not have a direct right to choose your assessor, you have the right to request a change and to be informed of the reason for the change.
How Assessor Changes Affect Caregivers and Families
For caregivers and family members, a change in assessor can introduce uncertainty, especially if the new assessor is less responsive, unfamiliar with the injury history, or fails to understand the practical needs of the injured person. This may result in delays in accessing treatment and care benefits, particularly if the new assessor requires additional medical evidence or reassessment before approving services.
In Greater Sydney, where access to specialist medical services and allied health providers is relatively high, delays in approval can still significantly affect recovery outcomes, particularly for those requiring ongoing rehabilitation, home modifications, or personal care assistance. Family members who have taken on caregiving roles may also face challenges in maintaining consistent communication with a new assessor, especially if the new contact has not reviewed prior correspondence or medical reports.
The Motor Accident Injuries Regulation 2017 requires that insurers notify claimants of any change in assessor within 14 days of the change. The notice must include the name and contact details of the new assessor and a brief explanation of the reason for the change. If the change is not communicated, or if the new assessor fails to respond to reasonable requests for information, this may be grounds for a formal complaint.
What You Can Do When an Assessor Is Changed
If your CTP insurer changes your assessor, take the following steps to protect your claim and support your family:
- Request a written explanation from the insurer for the change, including the name and contact details of the new assessor.
- Confirm that the new assessor has received all relevant medical reports, treatment history, and any prior correspondence.
- Provide a summary of care needs, including any home modifications, personal care assistance, or transport requirements, to ensure continuity of support.
- Keep a record of all communications with the new assessor, including dates, times, and details of conversations.
- If the new assessor delays or refuses to approve essential treatment or care, request a written explanation and, if necessary, ask for a review by the insurer’s internal complaints process.
The Role of SIRA in CTP Claims and Disputes
The State Insurance Regulatory Authority (SIRA) is the independent body responsible for overseeing CTP claims in NSW. SIRA does not appoint assessors, but it provides guidance on insurer obligations and supports claimants through its claims information and dispute resolution services.
If you believe the change in assessor has caused a delay or failure in processing your claim, you may contact SIRA to request a review of the insurer’s actions. SIRA’s website provides a claims helpdesk and a formal dispute resolution process for unresolved issues. You can also seek assistance from a community legal centre or an independent claims advocate, particularly if you are managing a complex claim involving a child, a person with a disability, or long-term care needs.
Time Limits and Practical Steps for Families
There is no fixed time limit for requesting a change of assessor, but delays in addressing concerns may affect your claim. For example, if a delay in approving treatment leads to a worsening of symptoms, it may impact the assessment of your whole person impairment (WPI) or the amount of damages you may be entitled to if you later pursue a common law claim.
The Motor Accident Injuries Act 2017 sets a 52-week limit on weekly income payments and treatment and care benefits for claimants whose only injuries are threshold injuries. This means that if your claim is not progressing due to repeated or unexplained assessor changes, it may be harder to demonstrate ongoing impact after 52 weeks.
A practical example: A mother in Sydney’s western suburbs was injured in a car accident and became reliant on her teenage daughter for daily care tasks. After her initial assessor was replaced, the new assessor delayed approving home care services for three months, citing the need for a new medical report. During this time, the daughter’s school attendance declined, and the mother’s recovery was affected. The family successfully challenged the delay through SIRA’s dispute process, which led to the reinstatement of care benefits and a formal review of the insurer’s handling.
Next Steps for Caregivers and Families
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.