If a CTP insurer replaces your claims assessor without explanation, you have legal options to challenge the change. Under NSW law, claimants can request an internal review, escalate to the Personal Injury Commission (PIC), or seek independent medical assessments. This guide explains how to dispute an assessor change, including SIRA's role and evidence requirements.
Legal Options to Challenge an Assessor Change
CTP insurers must justify replacing an assessor under the Motor Accident Injuries Act 2017. If the insurer’s decision appears arbitrary, you can:
- Request an internal review within 21 days of the change
- Submit a formal complaint to the PIC
- Seek an independent medical assessment through SIRA
The insurer must provide a written explanation for the change. If the replacement impacts your claim, you may need to provide evidence such as:
- Medical records showing the original assessor’s findings
- Correspondence with the insurer about the change
- Witness statements or expert opinions
SIRA’s Role in Dispute Resolution
SIRA oversees CTP claims and has specific processes for resolving disputes. If you believe the assessor change affects your claim:
- Contact SIRA’s claims team to request a review
- Submit a written objection within 28 days of the change
- Request a medical dispute pathway if the assessor’s report conflicts with your treatment
SIRA may appoint a new assessor or refer the matter to the PIC for mediation. Note that disputes over assessor changes do not automatically result in a revised claim outcome.
Practical Steps for Claimants
- Document all communication with the insurer about the assessor change
- Gather medical evidence showing the original assessor’s findings
- Request an internal review within 21 days of the change
- Escalate to the PIC if the insurer refuses to reconsider
- Seek independent medical advice if the new assessor’s report conflicts with your treatment
A hypothetical example: Maria received a new assessor after her original report was delayed. She requested an internal review, provided her GP’s notes, and escalated to the PIC. The insurer eventually agreed to a joint assessment after SIRA intervened.
Time Limits and When to Seek Advice
You have 28 days to object to an assessor change under SIRA rules. If the insurer’s decision affects your weekly payments or long-term benefits, seek legal advice promptly. Disputes over assessor changes often require evidence of:
- A reasonable basis for the original assessment
- A significant change in your medical condition
- A failure to follow SIRA’s claim management protocols
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.