Understanding Assessor Changes in NSW CTP Claims
If you are involved in a motor accident in New South Wales and your claim is managed by a Compulsory Third Party (CTP) insurer, you may request a change of claims assessor or case manager. This request is not automatically granted, and the insurer must follow established procedures under the Motor Accident Injuries Act 2017 and guidance issued by the State Insurance Regulatory Authority (SIRA). The process for changing an assessor is not a standalone legal right but is governed by the insurer’s internal claims management practices and SIRA’s expectations for fair and efficient claim handling.
How Insurers Assess Liability During an Assessor Change
When an insurer considers a change of assessor, liability assessment remains a core function of the claims process. The insurer must assess whether the accident occurred, who was at fault, and whether the claimant’s injuries were caused by the accident. This assessment does not change simply because an assessor is replaced. The new assessor will review all available evidence, including:
- The police report or accident scene documentation
- Medical records and reports from treating practitioners
- Witness statements
- Photographs of the accident scene and vehicle damage
- The claimant’s account of the events
Liability decisions are made under the Motor Accident Injuries Act 2017, which applies to all motor accidents occurring on or after 1 December 2017. The insurer must determine whether the claimant was a driver, passenger, pedestrian, cyclist, or motorcyclist, and whether the accident occurred on a public road or private property that may still fall under CTP coverage.
Legal Framework and SIRA’s Role in Assessor Management
SIRA does not directly appoint or manage assessors. Instead, it sets standards for how CTP insurers must manage claims, including the handling of requests for assessor changes. Insurers are required to act fairly and in good faith, and must respond to requests for a change of assessor within a reasonable timeframe. The insurer must provide a written response explaining the decision, including whether the change was approved or declined.
SIRA’s guidance emphasises that a change of assessor should not delay the assessment of liability or the provision of benefits. The new assessor must resume the claim process without interruption, and must not re-evaluate liability based on new or different assumptions unless new evidence arises. The insurer’s liability assessment must be consistent with the evidence and must not be influenced by the change of assessor.
Practical Steps and Evidence That Matter
If you wish to request a change of assessor, you should:
- Contact your insurer in writing to formally request the change.
- Provide a reason, such as a breakdown in communication, perceived bias, or a conflict of interest.
- Submit any supporting evidence, including correspondence, notes from meetings, or documentation of delays.
Insurers may consider a change if there is a reasonable basis, such as a demonstrated pattern of poor communication or a conflict of interest. However, a simple preference for a different assessor is not sufficient grounds for a change. The insurer may also assess whether the change would cause undue delay in processing benefits.
Key evidence that may influence the decision includes:
- A record of unresolved queries or delays in response
- Evidence that the current assessor has failed to follow SIRA’s claims management standards
- Documentation showing that the claimant has been unable to access treatment or receive payments due to the assessor’s actions
Time Limits and Dispute Options
There is no statutory time limit for requesting a change of assessor. However, delays in making the request may affect the insurer’s ability to act promptly. If your request is denied, you may seek a review from the insurer’s internal dispute resolution process. If unresolved, you may contact SIRA for assistance or consider seeking independent legal advice.
The insurer remains responsible for determining whether the claimant is entitled to benefits under the CTP scheme. The assessment of liability is not subject to change simply because a new assessor is appointed.
Realistic Example: When a Change Is Considered
A pedestrian was struck by a car in a car park in Sydney. The claim was assigned to an assessor who failed to follow up on medical reports for over six weeks. The claimant submitted written requests for updates and received no response. After a formal request for a change of assessor, the insurer approved the request and assigned a new case manager. The new assessor reviewed the medical evidence, confirmed the injuries were sustained in the accident, and approved treatment and care benefits. The liability assessment remained unchanged because the evidence supported that the driver was at fault.
Next Steps and When to Seek Advice
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.