When a CTP Insurer Changes the Assessor
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 your CTP insurer changes the designated assessor for your claim, you have legal rights and procedural steps to follow. Under NSW law, insurers must provide a valid reason for replacing an assessor and ensure the new assessment adheres to the Motor Accident Injuries Act 2017 and SIRA guidelines. Claimants in Western Sydney should understand their options to protect their entitlements.
Legal Framework for CTP Assessor Changes
The Motor Accident Injuries Act 2017 governs CTP claims in NSW. Section 4.4 of the Act specifies that insurers must provide benefits for injuries meeting the 'threshold injury' criteria, including treatment and care benefits. SIRA guidelines further clarify that assessments must be conducted by qualified medical practitioners and follow evidence-based protocols.
When an insurer replaces an assessor, it must ensure the new assessor has the appropriate qualifications and follows the same clinical standards. If the change is abrupt or unexplained, claimants may need to request a written explanation or escalate the matter to SIRA.
Preparing for Medical Assessments After an Assessor Change
Claimants should take these steps when an assessor change occurs:
- Request documentation from the insurer explaining the reason for the change.
- Verify the new assessor's credentials to ensure they meet SIRA's medical practitioner standards.
- Prepare all medical records related to your injury, including pre-accident health history and treatment notes.
- Attend the assessment with a support person if needed, as SIRA guidelines allow for independent advocacy.
The insurer must provide at least 14 days' notice of the new assessment date under SIRA's procedural rules. If the new assessor fails to follow the agreed-upon clinical protocols, you may need to challenge the assessment outcome.
Time Limits and Dispute Options
CTP claims have strict time limits. For example, weekly income benefits must be claimed within 52 weeks of the accident if only threshold injuries are involved (s 4.4). If an assessor change delays your claim beyond these deadlines, you may need to:
- Submit a written objection to the insurer within 28 days of the change.
- Request a review by SIRA if the insurer refuses to reconsider.
- Seek legal advice if the insurer's actions appear to breach the Act or SIRA guidelines.
Example Scenario: Handling an Assessor Change
Consider a claimant in Western Sydney who receives a new assessor notice. The insurer claims the previous assessor was 'unavailable, ' but the claimant suspects the change is to limit benefits. The claimant should:
- Request the insurer to provide the new assessor's qualifications.
- Compare the new assessor's clinical approach with the previous one.
- Document any discrepancies in the assessment process.
- Contact SIRA if the insurer refuses to provide a written explanation.
When to Seek Legal Advice
If the insurer's actions appear to breach the Act or SIRA guidelines, or if you're unsure about your rights, consult a solicitor. Legal advice is particularly important if:
- The assessor change causes a delay in receiving benefits.
- The new assessor fails to follow agreed-upon clinical protocols.
- You believe the insurer is acting in bad faith.
Next Steps for Claimants
CTP entitlements depend on the accident date, injury type, and claim history. If you're facing an assessor change, act promptly to protect your rights. Complete the quick, no obligation enquiry form to request contact about your circumstances.