How NSW CTP Insurers Handle Assessor Changes and Funding Treatment Costs
If you're in Armidale NSW and your CTP insurer proposes a change to your claims assessor, you need to understand your rights and how funding for treatment is managed. Under the Motor Accident Injuries Act 2017, assessors are appointed by the State Insurance Regulatory Authority (SIRA) to evaluate claims. While insurers can request a change in assessors, this must align with SIRA guidelines and be justified by specific reasons such as conflicts of interest or unmet treatment needs.
Legal Framework for Assessor Changes
CTP insurers must follow SIRA's protocols when altering the assessor assigned to your claim. The insurer must provide written reasons for the change, such as:
- A conflict of interest with the current assessor
- The need to address unmet treatment requirements
- A dispute over the assessment's scope
SIRA's guidelines state that assessors must act independently and ensure treatment funding aligns with the claimant's medical needs. If you disagree with the change, you can request a review through SIRA's internal dispute process.
Funding Treatment Costs During Assessor Changes
When an assessor change occurs, the funding of treatment costs must continue under the same rules. SIRA's What You Can Claim page confirms that treatment benefits cover medically necessary care, including specialist consultations, therapy, and medication. If your insurer delays or refuses to fund treatment during the change process, you may need to:
- Submit updated medical records to justify ongoing care
- Request a formal review of the funding decision
- Seek independent medical opinion if treatment is delayed
Practical Steps and Evidence to Gather
To manage an assessor change and treatment funding dispute, collect:
- Copies of all correspondence with the insurer
- Medical records confirming treatment needs
- Evidence of delayed or denied treatment
- Details of any previous assessor interactions
If your insurer refuses to fund treatment during the change, you may need to escalate the matter to SIRA or consult a legal professional. The insurer must provide a written explanation for any funding decisions.
Time Limits and When to Seek Advice
While there is no fixed deadline for disputing an assessor change, delays in treatment funding could affect your claim. SIRA recommends resolving disputes within 28 days of receiving a funding decision. If you're unsure about your options, seek advice promptly. Legal professionals can help you:
- Challenge unjustified assessor changes
- Ensure treatment costs are approved under SIRA guidelines
- Navigate the claims process without compromising your rights
Example Scenario
Consider a claimant in Armidale who requires ongoing physiotherapy after a motor accident. Their insurer changes the assessor, citing 'inadequate evidence' of treatment need. The claimant submits updated records from their doctor, demonstrating the necessity of therapy. The insurer then agrees to fund the treatment, highlighting the importance of proactive evidence gathering.
Next Steps
CTP entitlements depend on the date of your accident, the nature of your injuries, and how your claim is managed. To request contact about your circumstances, complete the quick, no obligation enquiry form.