What happens when a CTP insurer changes your assessor?
A change of assessor by a Compulsory Third Party (CTP) insurer during your motor accident claim is not uncommon, particularly in the Newcastle and Hunter region where claim volumes are significant. This change may occur due to internal insurer processes, a reassessment of your injury complexity, or a shift in the claim’s management structure. The new assessor is responsible for reviewing your medical evidence, rehabilitation progress, and daily activity capacity to determine your entitlement to treatment and care benefits, weekly income payments, or damages. Importantly, the change does not alter your legal rights under the Motor Accident Injuries Act 2017. Your claim continues under the same statutory framework, and your entitlements remain governed by the same thresholds and time limits, regardless of who manages your claim at any given time.
How assessor changes affect daily activity assessments
Daily activities are a core part of the assessment process under the Motor Accident Injuries Act 2017. Assessors determine how your injury impacts your ability to perform everyday tasks such as cooking, cleaning, walking, driving, and managing household responsibilities. When an assessor changes, the new officer must review all available evidence, including medical reports, functional capacity assessments, and your self-reported daily activity logs. This review may result in a reassessment of your capacity to return to daily activities. The change can cause temporary delays in decision-making, particularly if the new assessor requires additional information or seeks further medical opinions. However, the law does not permit an insurer to delay benefits indefinitely due to an assessor change. Any delay must be reasonable and documented.
Practical steps if an assessor change delays your return to daily activities
If you believe a change of assessor is causing undue delay in your return to daily activities, you should take the following steps:
- Obtain a written confirmation from your insurer of the change, including the name and contact details of the new assessor.
- Provide the new assessor with a complete record of your injury, treatment, and daily activity limitations. This includes medical reports, rehabilitation progress notes, and a personal diary of daily tasks you have been able to perform.
- Request a formal review of your daily activity assessment if you believe the new assessor’s findings are inconsistent with your medical evidence or your actual functional capacity.
- Keep a record of all correspondence with your insurer and assessor, including dates, times, and details of conversations.
The Motor Accident Injuries Regulation 2017 requires insurers to act in good faith and to make decisions based on medical evidence. If the new assessor’s assessment appears to be inconsistent with your medical records or the Motor Accident Guidelines, you may have grounds to challenge the decision.
Disputing an unfair assessment and seeking resolution
If you believe your daily activity assessment has been unfairly affected by a change of assessor, you may seek resolution through the State Insurance Regulatory Authority (SIRA). SIRA is the independent body responsible for overseeing CTP claims in New South Wales. You can apply to SIRA for a review of a decision made by your insurer, including decisions related to daily activity capacity and return to function. SIRA may request additional medical evidence or order a second opinion to resolve the dispute.
SIRA’s role is to ensure that decisions are made fairly and in accordance with the Motor Accident Injuries Act 2017 and the Motor Accident Guidelines. If your claim is in the Newcastle or Hunter region, SIRA has local offices and staff who are familiar with regional healthcare providers and rehabilitation services. You are not required to have a solicitor to make a complaint to SIRA, but you may choose to seek independent advice to strengthen your case.
Time limits and when to seek advice
There is no fixed time limit for requesting a change of assessor, but delays in responding to your insurer’s requests for information may affect the timing of benefit payments. The Motor Accident Injuries Act 2017 sets a 52-week limit on treatment and care benefits and weekly income payments if your only injuries are threshold injuries (such as soft tissue injuries). This limit does not apply if you have a permanent impairment or if your injury is not classified as a threshold injury.
If you are unable to return to daily activities due to a delayed assessment or an inconsistent decision following an assessor change, it is important to act promptly. You should seek independent advice if:
- Your claim has been delayed for more than 60 days without a clear explanation.
- The new assessor has not reviewed your full medical history or has ignored evidence of functional limitations.
- You have been asked to undergo a medical assessment that does not align with your current treatment plan.
Hypothetical example: A claimant in the Hunter region
A 42-year-old office worker in Maitland was involved in a motor vehicle accident in April 2024. After initial treatment, her claim was assigned to a claims assessor who approved her return to part-time work. In August 2024, her insurer changed the assessor without notifying her. The new assessor requested a new functional capacity assessment, which delayed her return to full-time work by three months. The new assessor later concluded she was capable of full-time duties, but her treating medical practitioner disagreed, citing ongoing pain and fatigue. The claimant provided her medical records and a diary of daily tasks to the insurer and requested a review. SIRA later confirmed that the original assessment was more consistent with her medical evidence and directed the insurer to reinstate her weekly payments and support her return to full-time work.
Next steps
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