What Happens When a CTP Insurer Changes the Assessor?
If a CTP insurer replaces your claims assessor or case manager, it can impact how your recovery of daily activities is assessed. Under NSW law, insurers must provide a fair and reasonable process for claimants to challenge such changes. This includes explaining why the change occurs and ensuring the new assessor has the necessary expertise to evaluate your recovery progress.
The Motor Accident Injuries Act 2017 (MAIA) and SIRA guidelines require insurers to justify any changes to the assessment team. If you believe the change affects your ability to receive accurate recovery assessments, you may request a review or appeal. Regional NSW claimants may face additional challenges, such as limited access to specialist assessors, which insurers must address under SIRA’s regional service standards.
Practical Steps for Claimants in Regional NSW
When an assessor change occurs, take the following steps:
- Request written details of the change, including the reason and the new assessor’s qualifications.
- Confirm the new assessor’s access to your medical records and recovery progress notes.
- Seek clarification if the change delays your recovery timeline or impacts benefits.
- Document all communication with the insurer, including dates and responses to your queries.
SIRA’s regional service standards require insurers to provide adequate support for claimants in areas with limited access to services. If you face unreasonable delays or obstacles, you may need to escalate the issue to SIRA or seek independent legal advice.
SIRA Guidance on Assessor Changes and Daily Activity Recovery
SIRA’s guidelines state that assessors must evaluate recovery based on objective medical evidence, including:
- Medical reports detailing your ability to perform daily activities.
- Evidence of how your injury affects tasks like cooking, cleaning, or mobility.
- Progress notes from treating practitioners.
If an assessor change leads to a reassessment of your recovery, the new assessor must follow the same evidence-based process. Claimants in regional NSW should ensure their medical records are complete and that the insurer has access to all relevant information.
How Regional NSW Claims Differ from Metropolitan Areas
Regional NSW claimants may face unique challenges, such as:
- Fewer specialist assessors available.
- Longer travel times to meet with assessors.
- Limited access to support services.
Under SIRA’s regional service standards, insurers must account for these factors when managing claims. If an assessor change causes undue hardship, you may request a review of the insurer’s compliance with these standards.
When to Seek Legal Advice
Contact a solicitor if:
- The insurer refuses to provide a reason for the assessor change.
- The new assessor fails to follow SIRA’s evidence guidelines.
- You believe the change is delaying your recovery or benefits.
A lawyer can help you challenge the change, request a review, or appeal a decision. Legal advice is especially valuable in regional areas where claimants may have limited access to support networks.
Example: A Regional Claimant’s Experience
Sarah, a regional NSW resident, suffered a soft-tissue injury in a car accident. Her initial assessor, based in Sydney, was replaced with a local assessor after a dispute over recovery timelines. Sarah requested written details of the change and confirmed the new assessor had access to her medical records. However, the new assessor delayed the recovery assessment for six weeks, impacting her ability to claim weekly benefits. Sarah escalated the issue to SIRA, which reviewed the insurer’s compliance with regional service standards. The insurer eventually agreed to expedite the assessment, highlighting the importance of proactive communication.
Next Steps for Claimants
If your CTP insurer changes the assessor, act quickly to protect your recovery and benefits. Ensure all evidence is complete, request explanations, and seek legal advice if the change causes delays or unfair treatment. Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.