Can CTP insurers change the assessor for a claim in NSW?
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).
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).
Under the NSW Motor Accident Injuries Act 2017 and SIRA guidelines, insurers may replace a claims assessor if they believe the original assessment was inadequate or if new evidence emerges. However, this must be done within the legal framework governing CTP claims. Claimants in rural and remote areas must understand their rights and how to prepare for assessments that may involve travel or specialist coordination.
Legal Framework for Assessor Changes
The Motor Accident Injuries Act 2017 (s 4.4) and SIRA's Motor Accident Claims Guide outline that insurers must ensure assessments are fair and based on medical evidence. While the law does not explicitly prohibit changing assessors, insurers must provide a valid reason, such as:
- New medical evidence affecting the injury's severity
- Concerns about the original assessor's independence
- A need for a specialist opinion on complex injuries
SIRA's guidelines stress that any change must not unreasonably delay the claim process. Claimants should be notified in writing of any proposed assessor change and given an opportunity to respond.
Practical Steps for Rural Claimants
If your CTP claim's assessor is changed, take these steps:
- Request written details of the reason for the change and the new assessor's qualifications
- Confirm the assessment location - SIRA advises that rural claimants may request assessments at local clinics if travel is impractical
- Prepare medical records in advance, including GP notes and specialist reports
- Arrange travel documentation if the assessment requires travel, as this may affect benefit calculations
For remote areas, SIRA recommends using telehealth where possible. If an in-person assessment is required, ensure your transport costs are documented.
Time Limits and Dispute Options
CTP insurers must complete assessments within 52 weeks of the accident if the injury is a 'threshold injury' (per s 3.11). For non-threshold injuries, the 52-week limit does not apply. If an insurer delays or changes assessors unreasonably, claimants may:
- Submit a formal complaint to SIRA
- Request a review by the NSW Civil and Administrative Tribunal (NCAT)
- Seek legal advice if benefits are withheld
Example Scenario
A rural cyclist injured in a car accident is assessed by a local GP. The insurer later requests a specialist in Sydney, citing 'complexity'. The claimant must:
- Confirm the specialist's credentials and reason for the change
- Arrange travel and lodging costs, which may be recoverable
- Ensure the new assessment includes all relevant medical records
- Challenge the change if it's deemed unreasonable under SIRA guidelines
When to Seek Advice
Contact SIRA or a legal professional if:
- You're unsure if the assessor change is justified
- You face unreasonable delays
- You need help preparing for a remote assessment
- You believe your benefits are being unfairly limited
Next Steps
CTP entitlements depend on the accident date, injury type, and claim history. Rural claimants may face unique challenges with assessor changes. To request contact about your circumstances, complete the quick, no obligation enquiry form.