CTP Insurer Change of Assessor: Legal Rights and Next Steps
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).
If a CTP insurer changes your claims assessor without explanation, you have legal rights to challenge the decision. Under NSW law, insurers must provide clear reasons for replacing an assessor and ensure the new assessor has the appropriate qualifications. This article explains your options when this happens.
Why CTP Insurers May Change Assessors
CTP insurers can replace an assessor if they believe the original assessor lacks the necessary expertise or if there are concerns about the assessment's accuracy. According to SIRA guidelines, insurers must document the reason for the change and notify claimants in writing. For example, if the original assessor was not a specialist in your type of injury, the insurer may seek a new assessor.
What Injured Claimants Should Do
If your assessor is replaced, you should:
- Request a written explanation of the change
- Confirm the new assessor's qualifications
- Ask for a review of your claim if you believe the change is unfair
- Seek legal advice if the insurer refuses to provide adequate reasoning
Evidence to Challenge an Assessor Change
To dispute a change, gather:
- Your original assessment report
- Medical records showing your injury's severity
- Evidence the new assessor was not qualified to evaluate your case
- Any correspondence with the insurer about the change
SIRA's Role in Regulating Assessor Changes
SIRA oversees the CTP claims process and requires insurers to follow strict procedures. If an insurer changes an assessor without proper justification, you can contact SIRA to escalate the issue. SIRA's guidelines state that claimants have the right to challenge decisions that affect their compensation.
Hypothetical Example
Imagine you were injured in a car accident in Armidale and your initial assessor concluded you had a soft-tissue injury. The insurer then replaces the assessor without explaining why, leading to a lower compensation offer. You could challenge this by showing the original assessor had the correct expertise and the new assessor failed to consider all your injuries.
Time Limits and Next Steps
You have 52 weeks from the accident date to claim certain benefits under the Motor Accident Injuries Act 2017. If the assessor change affects your ability to claim, act quickly. Contact SIRA or a legal professional to ensure your rights are protected.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.