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).
If a CTP insurer replaces your assigned assessor without explanation, you have legal options to challenge the change under NSW law. This article explains how to resolve disputes over assessor changes, including SIRA's internal review process and escalation to the Personal Injury Commission. Key steps include documenting the change, requesting a review, and understanding your rights under the Motor Accident Injuries Act 2017.
How SIRA Handles Assessor Changes
Under NSW CTP rules, insurers must assign an assessor to evaluate your claim. If the insurer changes the assessor without valid reason, you can request an internal review. SIRA guidelines state that any change must be justified by the insurer, and you have the right to challenge decisions that affect your benefits.
Practical Steps to Challenge an Assessor Change
- Document the change: Keep records of all correspondence with the insurer, including dates and details of the assessor change.
- Request an internal review: Contact the insurer's claims team to formally request a review of the assessor change. SIRA requires insurers to provide written reasons for any changes.
- Gather evidence: Medical records, accident reports, and witness statements may support your case. Ensure your treating medical practitioner confirms the injury's severity.
- Escalate to the Personal Injury Commission: If the insurer refuses to review the change, you can escalate the matter to the Personal Injury Commission (PIC). The PIC can mediate disputes or refer the case to the NSW Civil and Administrative Tribunal (NCAT) for further review.
Time Limits and Legal Boundaries
Disputes over assessor changes must typically be resolved within 52 weeks of the accident, as per the Motor Accident Injuries Act 2017. However, this timeline may vary depending on the insurer's internal processes. Note that SIRA does not guarantee a change in assessor decisions, and challenges may not always result in a revised outcome.
Example Scenario
Imagine an injured motorist in Balmain whose assessor is replaced without explanation. The insurer claims the new assessor has 'greater expertise, ' but the claimant believes this is a delay tactic. The claimant can request an internal review, citing the insurer's failure to justify the change. If the insurer denies the review, the claimant may escalate to the PIC.
When to Seek Legal Advice
Disputes over assessor changes can be complex. A solicitor can help you understand your rights, ensure all legal steps are followed, and represent you in disputes with the insurer or PIC. Always act promptly to avoid missing time limits.
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