A threshold injury under the Motor Accident Injuries Act 2017 (NSW) includes a soft tissue injury and a psychological or psychiatric injury that is not a recognised psychiatric illness (adjustment disorder and acute stress disorder are the usual examples; s 1.6 and Motor Accident Guidelines Part 5).
If a CTP insurer changes the assessor assigned to your motor accident claim in Bathurst, you have legal rights and practical steps to protect your entitlements. Under NSW law, claimants must act quickly to challenge the change, document the insurer’s response, and ensure the new assessor follows SIRA guidelines. This article explains your options under the Motor Accident Injuries Act 2017 and how to navigate the process effectively.
What to Do When an Assessor is Changed
When a CTP insurer replaces your case manager or assessor, you must notify them in writing within 14 days of the change. The insurer must provide a valid reason for the replacement, such as a conflict of interest or unavailability. If the change occurs before your claim is resolved, you may need to request a new assessment to ensure your claim is evaluated fairly.
Under the Motor Accident Injuries Act 2017, insurers must follow SIRA’s guidelines for assessing claims. If the new assessor fails to apply these standards, you may challenge their decision. For example, if the assessor ignores evidence of long-term pain or incorrectly classifies your injury as a ‘threshold injury, ’ you should request a review.
How to Challenge an Assessor Change
To dispute the change, gather evidence such as:
- Copies of all correspondence with the insurer
- Medical records showing your injury’s severity
- SIRA’s guidelines on assessor responsibilities
- Witness statements or expert opinions
You should also request a written explanation from the insurer about why the assessor was replaced. If the insurer refuses to provide a reason or delays the process, you may need to escalate the matter to SIRA or seek legal advice.
Time Limits and Dispute Options
The 52-week statutory benefit period under the Motor Accident Injuries Act 2017 applies only if your injuries are classified as threshold injuries. If the new assessor reduces or stops your weekly payments without proper justification, you may have a claim for breach of duty. However, you must act within the applicable time limits, which vary depending on the type of claim.
If the insurer disputes your claim or refuses to comply with SIRA guidelines, you may need to apply for a review through the NSW Civil and Administrative Tribunal (NCAT). This process requires you to submit evidence showing the insurer’s failure to follow the law.
Example Scenario
Consider a cyclist in Bathurst who suffered a soft-tissue injury after a collision. The insurer replaces the assessor before the claim is resolved, citing a ‘conflict of interest’ with the original assessor. The new assessor then reduces the weekly benefit, arguing the injury does not meet the threshold definition. In this case, the cyclist should request a written explanation, challenge the assessor’s interpretation of SIRA guidelines, and seek a review if the insurer refuses to adjust the claim.
When to Seek Legal Advice
CTP insurers often use procedural delays to pressure claimants. If the insurer refuses to provide a reason for the assessor change, ignores your evidence, or threatens to terminate your claim, you should contact a solicitor specialising in NSW CTP claims. Legal advice is particularly important if the insurer disputes your right to claim for long-term injuries or if the assessor’s decision affects your ability to receive treatment and care benefits.
Next Steps
CTP entitlements depend on the accident date, injury type, and claim history. To request contact about your circumstances, complete the quick, no obligation enquiry form.