What to Do When a CTP Insurer Changes Assessors
Where a person's only injuries resulting from the accident are threshold injuries, weekly benefits and treatment and care generally cease after 52 weeks (ss 3.11 and 3.28).
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 replaces your claims assessor or case manager in Balmain, you must document evidence to support your claim. NSW CTP rules require insurers to provide a fair assessment process, and changes to assessors must comply with statutory obligations. Retaining specific records ensures your claim meets legal standards and protects your right to challenge improper changes.
NSW CTP Rules Behind Assessor Changes
Under the Motor Accident Injuries Act 2017, CTP insurers must provide a fair and transparent claims process. Section 4.4 of the Act limits benefits for injuries that do not meet the 'threshold injury' definition, while sections 3.11 and 3.28 govern statutory benefits for 52 weeks. If an insurer replaces an assessor, they must provide a written explanation and ensure the new assessor follows the Motor Accident Guidelines. Failure to comply may constitute a breach of duty.
Evidence to Retain When an Assessor is Changed
To support your claim, retain the following records:
- Medical records: Include all injury assessments, treatment notes, and reports from healthcare providers. These prove the nature and severity of your injuries.
- Accident reports: Police reports, witness statements, and photographs of the scene establish the incident's circumstances.
- Insurer correspondence: Save all emails, letters, and forms from the insurer, including any notice of assessor changes.
- Assessment reports: Keep copies of all assessor reports, including the new assessor’s findings and any discrepancies.
- Income and employment records: Document lost wages, medical leave, or reduced earning capacity to support income-related claims.
How to Challenge an Assessor Change
If the insurer’s change appears improper, you may:
- Request a written explanation of why the assessor was replaced.
- Seek a second opinion from an independent assessor approved by SIRA.
- File a dispute with the NSW Civil and Administrative Tribunal (NCAT) if the insurer refuses to address concerns.
Time Limits and When to Seek Advice
CTP insurers must respond to disputes within 28 days under the Motor Accident Injuries Regulation 2017. If the insurer delays or ignores your request, you may need to act quickly. Contact a legal professional if:
- The insurer refuses to provide a new assessor.
- The change appears to be a tactic to reduce benefits.
- You believe the new assessor’s findings are biased or incomplete.
Practical Example
Consider a claimant in Balmain who receives a new assessor’s report downgrading their injury. By retaining the original assessor’s report, medical records, and correspondence, the claimant can demonstrate the insurer’s change may be improper. This evidence supports a request for a second opinion or NCAT review.
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.