Understanding CTP Assessor Changes and Treatment Funding
A change of claims assessor by a Compulsory Third Party (CTP) insurer in New South Wales does not automatically affect the funding of your treatment costs. The insurer remains legally responsible for providing necessary treatment and care benefits under the Motor Accident Injuries Act 2017, regardless of which assessor manages your claim. This includes funding for medical treatment, allied health services, and rehabilitation, whether you are in Greater Sydney or elsewhere in NSW.
The change of assessor is a procedural matter within the insurer’s internal management of your claim. It does not alter your entitlement to treatment funding, which is determined by your injury, medical need, and compliance with the Motor Accident Injuries Regulation 2017 and the Motor Accident Guidelines.
Legal Obligations of CTP Insurers When Changing Assessors
Under the Motor Accident Injuries Act 2017, CTP insurers must ensure that claimants receive timely and appropriate treatment and care benefits. This obligation remains in place even when an assessor is replaced. The insurer must notify you of any change in assessor and provide the new contact details. The new assessor must take over the management of your claim without interruption to your treatment access.
Insurers are required to act in good faith and ensure continuity of care. Any disruption to treatment funding caused by a change of assessor must be justified and documented. If treatment is delayed or denied because of a change in assessor, this may constitute a failure to meet the insurer’s statutory obligations under the Act.
Practical Steps if Treatment Funding Is Affected by an Assessor Change
If you believe that a change of assessor has led to a delay or denial in funding for treatment, you should take the following steps:
- Confirm in writing that the new assessor has been assigned and obtain their contact details.
- Provide a copy of your most recent medical report or treatment plan to the new assessor.
- Request a written explanation from the insurer if treatment funding has been withheld or delayed.
- Maintain a record of all correspondence, including emails, letters, and call logs.
- Keep copies of all treatment invoices, prescriptions, and appointment confirmations.
If treatment funding is not reinstated within a reasonable time, you may request a review of the insurer’s decision. You can also contact the Motor Accident Commission (SIRA) for guidance on how to proceed.
When a Change of Assessor May Raise Concerns
A change of assessor may be a concern if it occurs shortly after you have submitted a claim or requested treatment, particularly if:
- You are not notified of the change in writing.
- The new assessor fails to respond to your requests for treatment approval.
- Your treatment is delayed or denied without a clear reason.
- The insurer refuses to fund treatment that is supported by a medical practitioner.
In such cases, the change of assessor may be a procedural tactic to delay or obstruct funding. This could breach the insurer’s duty under the Motor Accident Injuries Act 2017 to act fairly and in good faith.
Dispute and Review Options
If you believe your treatment funding has been improperly affected by a change of assessor, you may:
- Request a formal review of the insurer’s decision through the insurer’s internal dispute resolution process.
- Lodge a complaint with the Motor Accident Commission (SIRA), which oversees CTP claims in NSW.
- Seek independent advice from a legal practitioner or a claims advocate.
SIRA provides guidance on how to make a claim and what you can claim, including treatment and care benefits. You can access this information at sira.nsw.gov.au/claims/motor-accidents.
Hypothetical Example
A pedestrian in Sydney was injured in a motor accident in October 2026. Their CTP insurer initially assigned an assessor who approved physiotherapy and psychological counselling. In January 2027, the insurer changed the assessor without notifying the claimant. The new assessor delayed approving a follow-up appointment with a specialist, resulting in a two-week gap in treatment. The claimant contacted SIRA and provided medical evidence showing the treatment was clinically necessary. SIRA advised that the insurer must reinstate funding and ensure continuity of care. The insurer subsequently approved the treatment and reimbursed the claimant for out-of-pocket expenses.
Next Steps
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.