Can CTP insurers change assessors during a claim?
Under the NSW Motor Accident Injuries Act 2017, insurers may replace a claims assessor if there are legitimate reasons such as conflict of interest, unavailability, or new evidence. The insurer must notify the claimant in writing and provide a clear explanation for the change. Claimants have the right to request a review of the decision and may seek independent advice if they believe the change is unjustified.
How does the NSW CTP scheme assess eligibility for rural/remote areas?
The NSW CTP scheme considers rural and remote areas based on geographic and logistical factors. For example, if a claimant lives in a remote area with limited access to medical services, this may affect the assessment of treatment and care benefits. Insurers must account for these factors when determining eligibility for weekly income payments or treatment benefits. Claimants should provide evidence of their location and any barriers to accessing services.
Practical steps for claimants facing assessor changes
- Document the change: Keep a record of all communications with the insurer regarding the assessor change, including dates and reasons provided.
- Request a review: Ask the insurer to explain why the change is necessary and whether it affects your claim's validity.
- Seek independent advice: Contact a solicitor or the NSW Civil and Administrative Tribunal (NCAT) if you believe the change impacts your entitlements.
- a. Preserve evidence: Ensure medical records, accident reports, and witness statements are up-to-date and accessible.
Time limits and dispute resolution
Claimants must notify the insurer of any changes to their circumstances within 28 days of becoming aware of the change. If disputes arise, the NSW CTP scheme allows for disputes to be resolved through NCAT. For claims involving rural areas, the tribunal may consider additional factors such as travel time to medical facilities or the availability of local specialists.
Example: Rural claimant with limited access to services
A claimant living in a remote NSW town with no nearby physiotherapists may face delays in receiving treatment benefits. If the insurer changes assessors without accounting for this, the claimant should provide evidence of the limited local services and request a reassessment of their eligibility.
When to seek legal advice
If the assessor change leads to a reduction or denial of benefits, or if the insurer fails to comply with legal requirements, claimants should consult a solicitor. Legal advice can help ensure the claimant's rights under the CTP scheme are protected, particularly in rural areas where access to legal resources may be limited.
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