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).
When NSW CTP insurers replace an assessor during a motor accident claim, claimants in Bathurst must avoid specific legal and procedural errors to protect their entitlements. This article explains how SIRA handles assessor changes, outlines common mistakes, and provides steps to take if your claim is affected.
Why Assessor Changes Matter in NSW CTP Claims
Under the Motor Accident Injuries Act 2017, CTP insurers must follow strict rules when managing claims. If an assessor is replaced, the new assessor must review all existing evidence and documentation. SIRA’s guidelines state that insurers cannot unreasonably delay or withhold information during this process. Claimants should be aware that repeated assessor changes without valid justification may indicate procedural issues.
Common Mistakes to Avoid
- Ignoring Written Requests: If an insurer asks for additional medical records or clarification, failure to respond in writing can delay claims. SIRA requires all communication to be in writing to ensure transparency.
- Not Documenting Communication: Keeping records of all correspondence with insurers is critical. This includes emails, letters, and phone call notes. Without this, claimants may struggle to prove they followed procedures.
- Missing Deadlines: SIRA sets time limits for assessing claims. If an insurer delays beyond these limits, claimants may need to escalate the matter to the NSW Civil and Administrative Tribunal (NCAT).
- Assuming Fault Doesn’t Matter: While CTP claims are typically no-fault, insurers may challenge the validity of a claim if they believe the injury is not serious enough. This is especially relevant for threshold injuries, which must meet specific medical criteria under the Motor Accident Guidelines.
What to Do If an Assessor is Replaced
If your insurer replaces an assessor, request a written explanation for the change. SIRA requires insurers to provide reasons for such decisions, such as conflicts of interest or incomplete evidence. You should also:
- Request a copy of the new assessor’s report.
- Ensure all medical records and accident details are submitted promptly.
- Seek legal advice if the insurer refuses to cooperate or delays the process.
When to Seek Legal Help
Claimants in Bathurst should consult a solicitor if:
- The insurer refuses to provide a written reason for changing assessors.
- The new assessor’s report contradicts previous findings without explanation.
- You receive a notice of a dispute or review without being informed of your rights.
Example Scenario
A claimant in Bathurst submitted a claim for soft-tissue injuries. The insurer replaced the assessor after the original found a threshold injury. The new assessor rejected the claim, citing lack of ‘neurological signs’ as required by the Motor Accident Guidelines. The claimant’s mistake was not requesting a detailed explanation of the new assessment criteria, leading to a delay in resolving the dispute.
Next Steps
CTP claims in NSW depend on strict adherence to procedural rules. If your insurer changes assessors, act quickly to ensure all evidence is properly reviewed. For personalized advice, complete the quick, no obligation enquiry form to discuss your circumstances.