When a CTP insurer changes the assessor for a claim, it can impact the evaluation of your ability to return to daily activities. Under NSW law, insurers must have a valid reason for such a change, and claimants have rights to challenge or request a new assessor. This article explains how assessor changes affect claims related to daily activities, practical steps to manage the process, and how SIRA handles disputes in Western Sydney.
How CTP Insurers Handle Assessor Changes
NSW CTP insurers are required to use approved assessors under the Motor Accident Injuries Act 2017. If an insurer changes assessors during a claim, they must provide a written explanation for the change, such as a conflict of interest or a need for a different expertise. Claimants have the right to request a new assessor if they believe the change is unjustified or affects the fairness of the claim.
SIRA’s guidelines state that claimants should notify the insurer in writing if they disagree with the change. The insurer must then provide a response within 28 days. If the insurer refuses to provide a new assessor without valid reasoning, the claimant may escalate the matter to SIRA for review.
Impact on Claims for Daily Activities
Claims related to returning to daily activities depend on the assessor’s evaluation of your functional capacity. A change in assessors could lead to conflicting opinions, especially if the new assessor has a different approach to assessing daily living skills. For example, one assessor might rate a claimant’s ability to perform household tasks as limited, while another might find they can manage most activities.
SIRA advises claimants to ensure their evidence is comprehensive. This includes medical records documenting your condition, statements from healthcare professionals, and any evidence of how the injury affects your daily routine. If the assessor’s opinion contradicts your evidence, you may need to seek an independent medical opinion to support your claim.
Steps to Take if an Assessor is Changed
- Request a Written Explanation: Ask the insurer to provide a written reason for the assessor change. This helps determine if the change is lawful and fair.
- Review the New Assessor’s Report: Compare the new assessor’s findings with previous reports. Look for inconsistencies or changes in how your daily activities are evaluated.
- Seek Independent Medical Advice: If the new assessor’s opinion conflicts with your medical records, consult a doctor or physiotherapist to provide an independent assessment of your functional capacity.
- Contact SIRA: If the insurer refuses to provide a new assessor or disputes your claim, contact SIRA’s claims team. They can mediate disputes and ensure the process complies with NSW law.
Time Limits and Dispute Resolution
CTP claims have strict time limits. For example, weekly income payments are generally limited to 52 weeks if only threshold injuries are involved. If an assessor change delays your claim, you may need to act quickly to avoid missing deadlines. SIRA also has a 28-day response time for disputes, so prompt action is essential.
If the insurer disputes the claim, you may need to apply for a review by the NSW Civil and Administrative Tribunal (NCAT). SIRA provides a template for dispute resolution, which includes submitting evidence and a written statement of your case.
Example Scenario
Consider a claimant in Western Sydney who was injured in a car accident and is claiming compensation for difficulty returning to work. The initial assessor rates their ability to work as limited, but the insurer changes assessors. The new assessor concludes the claimant can return to work full-time. The claimant must then provide additional evidence, such as a doctor’s note explaining how the injury affects their work capacity, to challenge the new assessment.
When to Seek Legal Advice
While SIRA handles most disputes, complex cases may require legal assistance. A solicitor can help you navigate the process, ensure your rights are protected, and challenge decisions that unfairly disadvantage your claim. Legal advice is particularly useful if the insurer refuses to provide a new assessor or if there are disputes over the validity of the assessor’s opinion.
Next Steps
CTP entitlements depend on the accident date, injury type, and claim history. If you’re in Western Sydney and your insurer has changed assessors, it’s important to act promptly to protect your claim. Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.