How CTP Insurers Assess Liability When Changing Assessors in Regional NSW
A threshold injury under the Motor Accident Injuries Act 2017 (NSW) includes a soft tissue injury and a psychological or psychiatric injury that is not a recognised psychiatric illness (adjustment disorder and acute stress disorder are the usual examples; s 1.6 and Motor Accident Guidelines Part 5).
If a CTP insurer in New South Wales requests a change of assessor for your motor accident claim, understanding the legal process and assessment criteria is critical. Under the Motor Accident Injuries Act 2017, insurers may replace an assessor if they believe the current one is unsuitable or if new evidence emerges. However, all assessments must follow the SIRA Motor Accident Guidelines and adhere to strict procedural rules. This article explains how insurers evaluate liability in regional NSW, what claimants should know, and steps to ensure fair outcomes.
Legal Framework for Changing Assessors
NSW CTP insurers have the authority to request a new assessor under Section 124 of the Motor Accident Injuries Act 2017, which allows for the appointment of a new independent assessor if there is a 'reasonable suspicion' that the original assessment was flawed. This power applies regardless of location, including regional areas. However, the insurer must provide a written explanation for the change, referencing the Motor Accident Injuries Regulation 2017 (Section 124(2)).
When a new assessor is appointed, they must evaluate the claim based on the SIRA Motor Accident Guidelines, which define threshold injuries, treatment benefits, and income support. The assessor will review medical records, accident reports, and any evidence of ongoing consequences. Importantly, the insurer cannot unilaterally change the assessor without a valid reason, and claimants have the right to challenge the decision through the NSW Civil and Administrative Tribunal (NCAT).
Practical Steps for Claimants in Regional NSW
If your insurer requests a new assessor, take the following steps to protect your claim:
- Preserve all medical records: Ensure your treating doctor provides detailed notes on your injury, treatment, and recovery progress.
- Document the accident: Retain photographs of the scene, witness statements, and any police reports.
- Review correspondence: Keep copies of all communications with the insurer, including requests for additional information.
- Challenge the change: If the insurer’s reason for replacing the assessor is unclear or unreasonable, you may seek legal advice to contest the decision.
Insurers in regional NSW may face delays in accessing specialist assessors, which could affect the timeline for your claim. Always request a written timeline for the new assessment and ensure the insurer follows the SIRA guidelines for evaluating liability.
Time Limits and Dispute Resolution
Under the Motor Accident Injuries Act 2017, claimants have a statutory 52-week period to claim weekly income support or treatment benefits if their injuries meet the threshold criteria. However, this does not apply to all claims, such as those involving long-term care or whole-person impairment. If the new assessor’s findings contradict your medical evidence, you may need to escalate the matter to NCAT for a review.
Disputes over liability assessments are resolved through the NSW Civil and Administrative Tribunal, which has specific rules for CTP claims. In regional areas, claimants may need to seek assistance from local legal aid services or a solicitor specialising in CTP matters. Always act promptly to avoid missing critical deadlines.
Example Scenario
Consider a claimant in regional NSW who suffered a soft-tissue injury in a car accident. The initial assessor determined the injury was a threshold injury, entitling the claimant to weekly benefits. The insurer later requests a new assessor, claiming the original assessment was 'inaccurate.' The new assessor reviews the medical records and concludes the injury does not meet the threshold. In this case, the claimant should challenge the decision by providing additional evidence, such as a second opinion from a specialist, to demonstrate the injury’s severity.
When to Seek Legal Advice
If your insurer’s change of assessor results in a reduced or denied claim, it is essential to consult a legal professional. A solicitor can help you:
- Challenge the insurer’s decision to replace the assessor.
- Navigate the NCAT process for dispute resolution.
- Ensure your claim complies with the
- SIRA guidelines* and statutory deadlines.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.
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