Understanding the CTP Claims Assessor Role in NSW
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).
In a motor accident compensation claim under the NSW Compulsory Third Party (CTP) scheme, the claims assessor is the person appointed by the insurer to manage your claim. This includes assessing your injuries, arranging treatment and care, processing weekly income payments, and handling any claim for damages. The assessor is responsible for ensuring you receive the benefits you are entitled to under the Motor Accident Injuries Act 2017 (MAIA).
In Greater Sydney, as elsewhere in NSW, the CTP insurer must appoint a qualified assessor to administer your claim. You have the right to request a change of assessor if you believe the current one is not acting in your best interests, is not communicating effectively, or if there is a conflict of interest. However, a change is not automatic and must meet the eligibility criteria set out in the CTP scheme.
Eligibility Criteria for Changing Your CTP Assessor
There is no general right to change your CTP assessor simply because you are dissatisfied with their service. The Motor Accident Injuries Act 2017 and the Motor Accident Injuries Regulation 2017 do not provide a standalone entitlement to a change based on personal preference. Instead, eligibility is limited to specific circumstances.
You may be eligible to request a change of assessor if:
- The current assessor has a conflict of interest, such as a personal or professional relationship with another party in the claim.
- The current assessor has failed to act in a timely or reasonable manner, and this failure has caused you to suffer a disadvantage in your claim.
- The current assessor has made a material error in assessing your injuries or entitlements, and this error has not been corrected.
- The insurer has failed to appoint an assessor within 21 days of your claim being accepted.
These criteria are not defined in detail in the legislation, but they are supported by SIRA’s guidance on motor accident claims. The onus is on you to provide evidence that the grounds for change are valid and substantiated.
Practical Steps and Evidence to Support a Change
If you wish to request a change of assessor, you must follow a formal process. The first step is to contact your insurer in writing and clearly state your reasons for requesting the change. Include any evidence that supports your position, such as:
- Copies of correspondence showing delays or lack of response from the current assessor.
- Medical reports that indicate a discrepancy in injury assessment.
- Documentation showing a personal or professional connection between the assessor and another party in the claim.
- Evidence that the insurer failed to appoint an assessor within 21 days of accepting your claim.
SIRA advises that you should keep a record of all communications with the insurer and the current assessor. This includes emails, letters, and notes of phone calls. If the insurer refuses your request, you may ask for a written explanation of the refusal.
In Greater Sydney, where claim volumes are high and insurer operations are centralised, it is not uncommon for claimants to experience delays or miscommunication. If you believe your claim is not being managed properly, you may also contact SIRA directly for assistance. SIRA can review whether the insurer has met its obligations under the MAIA.
Time Limits and Dispute Resolution
There is no fixed time limit for requesting a change of assessor under the CTP scheme. However, delays in raising the issue may affect your ability to obtain a timely resolution. If the insurer refuses your request, you may escalate the matter to SIRA, which has the authority to investigate and, if necessary, direct the insurer to appoint a new assessor.
SIRA’s process for handling disputes includes a review of the evidence and may involve a formal assessment of whether the insurer has met its legal obligations. If SIRA finds that the insurer failed to act in accordance with the law, it may issue a direction to change the assessor.
You may also seek independent legal advice if you believe the insurer is not fulfilling its duties. A solicitor can help assess whether your grounds for change are strong enough to warrant a formal request or a complaint to SIRA.
When Independent Advice Is Recommended
A change of assessor is a significant step in your claim and may impact the timing and outcome of benefits you receive. It is not a decision to make lightly. You should consider seeking independent advice if:
- The insurer has refused your request without providing a clear reason.
- You believe the current assessor is not properly assessing your injuries or entitlements.
- You have been involved in a complex claim, such as one involving a threshold injury, a claim for damages, or a dispute over treatment and care.
For example, a claimant in Sydney’s eastern suburbs who was assessed as having only a soft-tissue injury but later developed neurological signs consistent with a spinal nerve-root injury may need a new assessor to review the medical evidence under the Motor Accident Guidelines. In such a case, a change of assessor may be necessary to ensure the injury is properly evaluated and to prevent a premature closure of benefits.
Next Steps
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.