How CTP Insurers Handle Assessor Changes and Funding Treatment Costs
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 you're dealing with a Compulsory Third Party (CTP) claim in Newcastle or the Hunter region and your insurer requests a new assessor, it's important to understand how this affects your treatment funding. Under NSW law, CTP insurers must fund reasonable medical treatment costs as part of your claim, but disputes over assessors can delay payments. This article explains your rights, practical steps to take, and how SIRA guidelines apply to assessor changes.
NSW CTP Rules Behind Assessor Changes
CTP insurers in NSW are required to fund treatment costs under the Motor Accident Injuries Act 2017. If your insurer requests a new assessor, they must provide a valid reason, such as concerns about the original assessor's independence or conflicts of interest. SIRA guidelines state that insurers cannot unreasonably delay or withhold funding while disputing an assessor's suitability.
Key points to note:
- Insurers must justify changes - You can request written reasons for the assessor change, including whether the original assessor's report was incomplete or biased.
- Funding cannot be suspended - SIRA rules prohibit insurers from halting treatment payments during disputes, unless the assessor's change is approved by the NSW Civil and Administrative Tribunal (NCAT) or a court.
- Regional considerations - While SIRA guidelines apply statewide, insurers in Newcastle and Hunter may have local processes for scheduling assessments or coordinating with regional clinics. Always confirm with your insurer or SIRA.
Practical Steps for Claimants
If your insurer requests a new assessor, take these steps to protect your treatment funding:
- Request written reasons - Ask the insurer to provide a detailed explanation for the assessor change, including any concerns about the original report.
- Preserve medical records - Ensure your treating doctor or physiotherapist provides copies of all assessments, treatment plans, and correspondence with the insurer.
- Seek independent medical advice - If you're unsure about the assessor's qualifications, consult another medical professional to review your case.
- Monitor funding timelines - SIRA guidelines state insurers must pay for treatment costs within 14 days of receiving a completed medical report. Delays may indicate a dispute.
Time Limits and Dispute Options
CTP insurers have 52 weeks from the accident date to fund treatment costs for threshold injuries (minor soft-tissue injuries). If your claim involves long-term treatment, the 52-week rule does not apply. However, disputes over assessors can extend funding delays, so it's crucial to act promptly.
If your insurer refuses to fund treatment or changes assessors unreasonably, you can:
- File a complaint with SIRA - SIRA's dispute resolution process allows you to challenge decisions about treatment funding or assessor changes.
- Apply to NCAT - For more complex disputes, you can request a review from the NSW Civil and Administrative Tribunal, which has the authority to order insurers to pay.
Example: What Happens During an Assessor Change
Imagine a claimant in Newcastle who has been receiving physiotherapy for a neck injury. Their insurer requests a new assessor to review the treatment plan. The insurer claims the original assessor did not account for all symptoms. While the new assessor reviews the case, the insurer must continue funding physiotherapy until the review is complete. If the new assessor concludes the treatment is unnecessary, the insurer may reduce payments, but this must be supported by medical evidence.
When to Seek Legal Advice
If your insurer's assessor changes lead to reduced funding, delays in treatment, or disputes over medical reports, it's wise to consult a solicitor. A lawyer can help you:
- Challenge the insurer's reasons for changing assessors.
- Ensure your treatment costs are funded in line with SIRA guidelines.
- Navigate NCAT or court processes if necessary.
Next Steps
CTP insurers in Newcastle and Hunter must fund treatment costs as part of your claim, but disputes over assessors can complicate this process. By understanding your rights, preserving evidence, and acting promptly, you can protect your treatment funding. If you're unsure how to proceed, complete the quick, no obligation enquiry form to request contact about your circumstances.