When a CTP insurer changes your assessor, what happens? In New South Wales, the Motor Accident Injuries Act 2017 (MAIA) and SIRA guidelines govern how insurers handle claim assessments. If your insurer replaces the assessor assigned to your claim, you have legal rights and options to challenge the change. This article explains the process, your responsibilities, and how to protect your claim.
Why CTP insurers change assessors
CTP insurers may replace an assessor for several reasons, including:
- A conflict of interest (e.g., the original assessor has a history with your case)
- A need for a specialist to evaluate complex injuries
- A request from the claimant to review an assessment
- A change in the insurer’s internal processes
Under the MAIA, insurers must provide a valid reason for changing assessors and ensure the new assessor has the expertise to evaluate your claim. SIRA guidelines (Section 3.12) require insurers to notify claimants of any changes and explain the rationale.
How to respond to an assessor change
If your insurer changes the assessor, you have the right to:
- Request a written explanation of why the change is happening
- Ask for the new assessor’s qualifications and experience
- Challenge the change if you believe it’s unfair or prejudicial
- Request a review of your claim if the new assessment alters your benefits
SIRA’s What you can claim page (https://www.sira.nsw.gov.au/claims/motor-accidents/what-you-can-claim) outlines that claimants must provide evidence to support their case. If the assessor’s change affects your weekly benefits or treatment payments, you may need to submit updated medical records or challenge the assessment through the NSW Civil and Administrative Tribunal (NCAT).
Legal implications of an assessor change
An insurer cannot unilaterally change assessors to disadvantage your claim. Under the MAIA, any change must be justified and not interfere with your right to receive fair compensation. If the new assessor’s opinion reduces your benefits, you may need to:
- Request a second opinion from an independent medical practitioner
- Submit additional evidence to support your original assessment
- Lodge a dispute with the insurer’s internal review process
For example, if your original assessor found a 20% whole person impairment (WPI) but the new assessor reduces this to 15%, you may need to provide updated clinical records to challenge the change. SIRA guidelines (Section 3.28) state that claimants must demonstrate the change affects their entitlements.
Time limits and when to seek advice
CTP insurers have 52 weeks to assess claims under the MAIA. If your claim is delayed beyond this period, you may need to:
- Request an extension of time
- Challenge the insurer’s failure to meet deadlines
- Seek legal advice if your benefits are reduced due to a delayed assessment
If your claim involves a threshold injury (e.g., soft tissue injury), the 52-week limit applies to weekly benefits. However, you may still pursue a dispute if the insurer’s change of assessor prejudices your case.
Practical steps to take
- Document the change: Keep a record of all correspondence with the insurer about the assessor change.
- Request evidence: Ask the insurer to provide the new assessor’s credentials and the basis for the change.
- Challenge the change: If the change appears unfair, contact the insurer’s internal review team or seek legal advice.
- Submit evidence: Provide updated medical records or other evidence to support your original assessment.
- Dispute through NCAT: If the insurer refuses to review your claim, you may need to apply to the NSW Civil and Administrative Tribunal.
When to seek legal advice
You should consult a legal professional if:
- The assessor change leads to a reduction in your weekly benefits or treatment payments
- You believe the change is motivated by bias or prejudice
- You need help challenging the insurer’s decision
- You are unsure how to respond to the change
Legal advice can help you understand your rights under the MAIA and SIRA guidelines, and ensure your claim is handled fairly.
Next steps
CTP claims depend on the date of your accident, the nature of your injury, and the insurer’s actions. If your claim has been affected by an assessor change, time limits and procedural rules may apply. To request contact about your circumstances, complete the quick, no obligation enquiry form.