When Can a NSW CTP Insurer Replace an Assessor?
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).
Under the NSW Motor Accident Injuries Act 2017, a CTP insurer may replace an assessor if the current one is unavailable, conflicts with the claimant’s circumstances, or if the insurer determines the original assessment was flawed. This applies to all CTP claims, including those in Balmain. For example, if an assessor is recalled due to a scheduling conflict, the insurer must notify the claimant and provide a reasonable timeframe to arrange a new assessment.
Practical Steps for Claimants When an Assessor is Changed
If an insurer replaces your assessor, take these steps:
- Request written notice of the change, including the reason and new assessor’s details.
- Verify the new assessor’s credentials through the NSW Government’s official assessor register.
- Document all communication with the insurer, including dates and correspondence.
- Seek independent medical opinion if you believe the new assessment is biased or incomplete.
In Balmain, claimants have reported delays when insurers replaced assessors without providing sufficient notice. Always keep copies of all documents related to the change.
How Assessor Replacement Affects Your Claim
Changing assessors can impact your claim in two ways:
- Extended timelines - A new assessment may delay benefits, especially if the insurer requests additional medical records.
- Potential underestimation - A new assessor might rate your injury differently, particularly if the original assessment included subjective elements like pain levels.
For example, a Balmain claimant with a soft-tissue injury (threshold injury) might see their weekly benefit reduced if the new assessor determines their impairment level is lower. Always ensure your medical records clearly support your claim.
Legal Limits on Insurer Discretion
NSW CTP insurers cannot arbitrarily replace assessors. The Motor Accident Injuries Regulation 2017 requires insurers to:
- Provide a valid reason for the change within 28 days of the original assessment.
- Allow claimants to request a second independent assessment at the insurer’s cost.
- Comply with the 52-week statutory benefit limit for threshold injuries.
If an insurer’s actions appear unreasonable, you may lodge a complaint with the NSW Civil and Administrative Tribunal (NCAT) or seek legal advice.
When to Seek Legal Advice
Contact a solicitor if:
- The insurer refuses to provide a written explanation for the assessor change.
- The new assessment significantly reduces your claimed benefits.
- You believe the insurer is acting in bad faith.
In Balmain, local solicitors often assist with disputes over assessor changes, particularly when claimants have overlapping workers’ compensation claims.
Next Steps
CTP entitlements depend on the accident date, injury type, and claim history. If you’re in Balmain and need assistance with an assessor change, complete the quick, no obligation enquiry form to request contact about your circumstances.