What to Do When Your CTP Insurer Changes Your Assessor
If your CTP insurer changes your claims assessor in Greater Sydney, you must provide updated evidence to support your claim. The new assessor will need to verify your injury details, treatment history, and entitlements under the Motor Accident Injuries Act 2017 (MAIA). This guide explains the required documentation, how to respond to disputes, and steps to ensure compliance with SIRA guidelines.
Required Injury Documentation
When an assessor changes, you must submit complete evidence of your injury and its impact. Key documents include:
- A written summary of your injury, including the date, time, and circumstances of the motor accident
- Medical records from all treating practitioners, including diagnoses, treatment plans, and progress notes
- Reports from specialists such as orthopaedic surgeons, neurologists, or physiotherapists
- A current assessment of your functional capacity, including restrictions on daily activities or work
- Evidence of financial loss, such as payslips, tax returns, or a letter from your employer
- Photographs of visible injuries, vehicle damage, or the accident scene (if available)
- A completed injury details form provided by the insurer
These documents help the new assessor determine whether your injuries meet the criteria for statutory benefits under the MAIA. Threshold injuries, which include soft tissue injuries and certain psychological injuries, are evaluated under the Motor Accident Guidelines.
Responding to Disputes
If the new assessor disputes your injury severity or treatment needs, you have the right to respond. The Motor Accident Injuries Regulation 2017 requires assessors to provide a reasonable basis for decisions to reduce or deny benefits. You may request a review, and if unresolved, apply to the NSW Civil and Administrative Tribunal (NCAT) under the MAIA.
For example, if your new assessor concludes your back pain is unrelated to the accident, you may provide a specialist report confirming a spinal nerve-root injury with neurological signs. Such injuries may still qualify as threshold injuries under the Motor Accident Guidelines even without radiculopathy.
Practical Steps to Support Your Claim
To ensure your claim proceeds smoothly after an assessor change, take these steps:
- Notify the insurer in writing that you have received a change of assessor and confirm your contact details
- Request a copy of the new assessor’s appointment letter and any assessment schedule
- Submit all requested documentation within 14 days of receiving the new assessor’s request
- Keep a record of all correspondence, including email and letter dates
- Attend all scheduled assessments and bring copies of your medical reports
- If you believe the assessment is unfair, contact an independent legal or claims adviser for guidance before responding
Failure to provide timely documentation may delay your benefits. The insurer must act within 14 days of receiving your documents to acknowledge receipt and confirm next steps.
Time Limits and Procedural Requirements
There are no fixed time limits for changing assessors under the MAIA, but delays in responding to a new assessor may affect benefit payments. You must notify the insurer within 28 days of a change of assessor if you wish to dispute the new assessor’s appointment. This is not a deadline to start a claim, but a procedural step to ensure fairness.
If you have already received weekly income payments or treatment and care benefits, a change of assessor does not stop those payments unless a review finds they were incorrectly awarded. However, any new claim for damages must still meet the threshold injury criteria under section 3.11 of the MAIA.
When to Seek Independent Advice
A change of assessor can be a critical point in your claim, especially if you have a complex injury, a dispute over treatment, or a history of delayed payments. If you are unsure whether your injury qualifies for damages, or if you believe the new assessor has not properly considered your medical evidence, it is advisable to seek independent advice before finalising any response.
The MAIA and Motor Accident Guidelines set clear standards for assessing injuries, including the definition of a threshold injury and the criteria for a spinal nerve-root injury with neurological signs. An independent review by a medical or legal professional can help ensure your rights under the CTP scheme are protected.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.