If a CTP insurer changes your treatment assessor in regional NSW, it could impact how your medical costs are funded. Under NSW law, insurers must cover treatment costs approved by a registered medical practitioner. This article explains how assessor changes work, what SIRA guidelines apply, and how injured road users can challenge funding decisions.
How CTP Insurers Handle Assessor Changes
NSW CTP insurers are required to fund treatment costs for injuries caused by motor vehicle accidents. When an insurer replaces your treatment assessor, they must provide a written explanation for the change. SIRA guidelines state insurers must ensure the new assessor has the appropriate qualifications to evaluate your treatment needs.
Insurers cannot unreasonably delay or refuse to fund approved treatment. If your assessor changes, the insurer must confirm the new assessor's credentials and ensure they have access to your full medical records. This process is outlined in SIRA's Making a Motor Accident Claim guide.
SIRA Guidelines for Funding Decisions
SIRA rules require insurers to fund treatment costs that are 'reasonably necessary' for your recovery. If your assessor changes, the insurer must reassess your treatment plan within 28 days of the change. This includes reviewing your medical records, treatment goals, and any new clinical findings.
If the insurer reduces your approved treatment costs after an assessor change, they must provide a detailed written explanation. This includes specifying which treatments are no longer funded and why. SIRA's What You Can Claim page outlines the types of medical costs typically covered.
Challenging Funding Decisions
Injured road users in regional NSW can challenge an insurer's funding decision by:
- Requesting a copy of the new assessor's evaluation report
- Submitting additional medical evidence to support your treatment needs
- Applying for a review through SIRA's internal dispute process
Insurers must respond to disputes within 14 days. If your claim is denied or reduced after an assessor change, you may need to escalate the matter to SIRA or seek independent legal advice.
Practical Steps for Regional NSW Claimants
- Keep detailed records of all treatment costs, including invoices and correspondence with your medical team
- Request written confirmation from the insurer when an assessor change occurs
- Seek clarification on how the new assessor's opinion affects your funded treatment
- Contact SIRA directly if you believe the insurer's decision is unfair or unsupported by your medical records
Time Limits and Dispute Options
CTP insurers have 28 days to respond to requests for treatment assessments. If your claim is denied after an assessor change, you have 21 days to apply for a review through SIRA. For disputes beyond this period, you may need to pursue a formal complaint or legal action.
When to Seek Legal Advice
If your insurer changes your assessor and reduces your funded treatment without a clear explanation, consider consulting a solicitor. Legal professionals can help you:
- Challenge the insurer's decision using SIRA guidelines
- Request a second opinion from an independent assessor
- Explore options for claiming additional compensation for treatment delays
Next Steps
CTP funding decisions can have a significant impact on your recovery. If your insurer has changed your treatment assessor in regional NSW, it's important to understand your rights under NSW law. Complete the quick, no obligation enquiry form to request contact about your circumstances.