Where a person's only injuries resulting from the accident are threshold injuries, weekly benefits and treatment and care generally cease after 52 weeks (ss 3.11 and 3.28).
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 a CTP insurer wants to change the assessor during your rehabilitation claim in Balmain, NSW, you have legal rights under the Motor Accident Injuries Act 2017. This article explains how SIRA handles assessor changes, what evidence matters for daily activities claims, and when to seek legal advice.
What happens when a CTP insurer requests a change of assessor?
Under NSW law, CTP insurers must provide a valid reason for changing an assessor, such as a conflict of interest or lack of expertise. SIRA guidelines state that any change must be documented and justified in writing. If the insurer replaces your assigned assessor without proper cause, you can challenge the decision by requesting a review through SIRA.
The insurer must also ensure the new assessor has the appropriate qualifications to evaluate your rehabilitation progress. If the change occurs during an ongoing assessment, you may need to provide updated medical records to support your claim for daily activities.
How does SIRA handle disputes over assessor changes?
SIRA manages disputes by requiring insurers to demonstrate that the change aligns with their assessment protocols. If you believe the change is unfair or prejudicial, you can submit a formal objection to SIRA. The authority will review the insurer’s reasoning and may require a second independent assessment if there are concerns about the fairness of the process.
In Balmain, claimants have reported success when they request a written explanation for the assessor change and provide evidence of their rehabilitation progress. SIRA’s role is to ensure the process is fair and that claimants are not disadvantaged by procedural changes.
What evidence supports a claim for daily activities?
To prove your ability to return to daily activities after an assessor change, you must provide:
- Medical records showing your rehabilitation progress
- A detailed diary of daily activities completed
- Statements from healthcare professionals about your functional capacity
- Evidence of any changes in your condition since the original assessment
The assessor will evaluate whether your daily activities meet the threshold injury criteria under the Motor Accident Guidelines. If the insurer disputes your ability to perform these activities, they must provide a written report outlining their clinical opinion.
Time limits and when to seek advice
CTP insurers have 52 weeks from the accident date to assess claims for threshold injuries. If your claim involves a return to daily activities, you must notify SIRA of any changes to your rehabilitation plan within 28 days of the insurer’s request for a new assessment.
If the insurer refuses to provide a second assessment or disputes your evidence, you should seek legal advice promptly. Delays in challenging an assessor change can jeopardize your right to claim compensation for daily activities.
Practical steps for claimants
- Request a written explanation for any assessor change
- Provide updated medical evidence to support your rehabilitation
- Submit a formal objection to SIRA if the change is unfair
- Keep records of all correspondence with the insurer
- Seek legal advice if the insurer refuses to comply with SIRA guidelines
When to contact a legal professional
Consult a solicitor if:
- The insurer refuses to provide a second assessment
- You receive a notice of a change without a valid reason
- Your rehabilitation progress is being disputed
- You need help preparing evidence for a new assessment
CTP claims involving assessor changes can be complex. Understanding your rights under NSW law is essential to ensure fair treatment during the rehabilitation process.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.