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 a CTP insurer changes the assessor for your medical assessments in Ballina, it’s important to understand your rights and how to prepare. Under NSW law, the insurer must ensure the new assessor follows SIRA guidelines and provides a fair evaluation. This article explains how to manage the transition, what documentation to prepare, and when to seek legal advice.
SIRA’s Role in Changing Assessors
The State Insurance Regulatory Authority (SIRA) oversees CTP claims to ensure fairness. If an insurer changes assessors, SIRA’s rules require the new assessor to review all relevant medical records and claim details. The insurer must provide written notice of the change and explain the reasons. You are entitled to request a copy of the assessor’s report and challenge it if it’s incomplete or biased.
Practical Steps for Claimants
When an assessor change occurs, take these steps:
- Review the insurer’s notice: Ensure the change complies with SIRA guidelines. If the notice is unclear, ask for clarification.
- Prepare medical records: Gather all documents from your treating doctors, including imaging reports, treatment plans, and notes from consultations. These will help the new assessor understand your condition.
- Attend the assessment: Bring a support person if possible. Ask the assessor to explain their findings and how they relate to your claim.
- Request a review: If you disagree with the assessor’s conclusions, you can ask the insurer to arrange a second opinion under SIRA’s dispute resolution process.
Documentation That Matters
The assessor will rely on specific evidence to evaluate your claim. Key documents include:
- Medical reports detailing your injuries and treatment
- Accident reports from police or witnesses
- Witness statements confirming the incident
- Income records to support claims for lost wages
- Correspondence with the insurer about your claim
Time Limits and When to Seek Advice
CTP insurers must complete assessments within 52 weeks of the accident if the injuries are classified as 'threshold injuries' under the Motor Accident Injuries Act 2017. If the assessor change delays this deadline, you may need to escalate the issue to SIRA. Contact a legal professional if:
- The insurer refuses to provide a new assessor
- The assessment is based on incomplete information
- You believe the assessor is biased or unqualified
Example Scenario
Imagine a claimant in Ballina who suffered a soft-tissue injury in a car accident. After 28 weeks, the insurer changes the assessor, claiming the original one was 'unavailable'. The new assessor dismisses the claim, arguing the injury doesn’t meet threshold criteria. The claimant must prove the injury meets SIRA’s spinal nerve-root definition and challenge the assessment through the insurer’s internal review process.
Next Steps
CTP claims depend on accurate medical assessments and timely action. If you’re in Ballina and facing an assessor change, seek guidance from a legal professional familiar with SIRA’s rules. Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.