If a CTP insurer replaces your claims assessor without explanation, you have legal options to challenge the change. Under NSW Motor Accident Injuries Act 2017 rules, claimants in Albury must follow specific dispute resolution steps to address assessor changes. This article explains how to respond when an insurer alters the assessor assigned to your claim, including SIRA's role in managing such disputes.
Dispute Resolution Options for CTP Assessor Changes
When a CTP insurer changes the assessor assigned to your claim, you have two primary dispute resolution pathways: internal review by the insurer and external review by the Personal Injury Commission (PIC). SIRA guidelines state insurers must provide a written explanation for any assessor change, including reasons for the replacement and how it affects your claim.
The first step is to request an internal review from the insurer. Under SIRA's Motor Accident Claims guidelines, insurers must allow claimants to challenge decisions through a formal process. If the insurer refuses to reconsider or the change impacts your entitlements, you may escalate the matter to the PIC.
SIRA's Role in Managing Assessor Changes
SIRA oversees the CTP claims process and provides frameworks for resolving disputes. Their website explains that insurers must ensure assessors are qualified to evaluate claims under the Motor Accident Guidelines. If you believe the new assessor lacks appropriate expertise or has a conflict of interest, you can request a second opinion through the PIC.
SIRA also outlines that claimants have the right to request a specific assessor if the change affects the accuracy of your claim assessment. This applies when the new assessor has a history of underestimating injury severity or has previously assessed similar claims differently.
Practical Steps for Claimants in Albury
To challenge an assessor change, gather evidence showing the replacement impacts your claim. This includes:
- Copies of all correspondence with the insurer
- Medical records detailing your injury
- Evidence of the new assessor's qualifications
- Any previous assessments by the original assessor
You must submit a written request for review within 28 days of the assessor change, as per SIRA's dispute resolution timelines. If the insurer denies your request, you can apply to the PIC for a medical dispute review within 14 days of the decision.
Time Limits and When to Seek Advice
CTP claims have strict time limits. If the assessor change affects your ability to claim weekly benefits or treatment costs, you must act quickly. Under the Motor Accident Injuries Act 2017, insurers must respond to disputes within 28 days. Delays can jeopardize your right to claim benefits for injuries that meet the 'threshold injury' definition under the Motor Accident Guidelines.
If you're unsure whether the assessor change impacts your claim, seek legal advice immediately. SIRA's dispute resolution process requires claimants to demonstrate how the change affects the accuracy of their assessment. A solicitor can help you prepare a strong case for review.
Example: How an Assessor Change Impacts a Claim
Consider a claimant who sustained a soft tissue injury (threshold injury) and was initially assessed by an assessor who recommended 52 weeks of treatment benefits. The insurer replaces the assessor, who then determines the injury does not meet the threshold criteria. This change could affect the claimant's ability to receive weekly benefits after 52 weeks, as per s 4.4 of the Motor Accident Injuries Act 2017.
In such cases, the claimant must prove the new assessor's decision is based on incorrect application of the Motor Accident Guidelines. This requires expert medical evidence showing the injury meets the spinal nerve-root qualification outlined in the guidelines.
Next Steps for Albury Claimants
If you're facing an assessor change, contact the insurer in writing to request an internal review. If the dispute isn't resolved, apply to the Personal Injury Commission for a medical dispute review. Time is critical - delays can affect your right to claim benefits under the CTP scheme.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.