Understanding the Role of a Claims Assessor in NSW CTP Claims
When you make a claim for compensation after a motor accident in New South Wales, the insurer responsible for your Compulsory Third Party (CTP) cover will assign a claims assessor to manage your claim. This person is not a lawyer, but they are responsible for assessing your entitlements to treatment and care benefits, weekly income payments, and any future damages. They also coordinate medical assessments, review your medical records, and communicate with your healthcare providers. The assessor’s role is critical to the progress and outcome of your claim.
Under the Motor Accident Injuries Act 2017 (MAIA), the insurer must act in good faith and ensure that the claims process is fair and transparent. The assessor is an employee or contractor of the insurer and is not an independent decision-maker. You have the right to request a change of assessor if you believe the current one is not acting appropriately, but this right is not automatic and must be exercised carefully.
Common Mistakes When Requesting a Change of Assessor
Requesting a change of assessor is a common step for claimants who feel they are not being treated fairly, are not receiving timely responses, or have concerns about the quality of communication. However, several mistakes often occur that can delay your claim or reduce your chances of a successful request.
One frequent error is making a request without providing clear reasons. Simply stating "I don’t like my assessor" is not sufficient under SIRA guidelines. The insurer must have a reasonable basis to consider a change, and you must explain how the current assessor’s actions have affected your claim. For example, if the assessor has failed to respond to your correspondence for over 14 days, or has not arranged a medical assessment despite your requests, these are valid grounds for concern.
Another common mistake is failing to document your interactions. Without written records of emails, letters, or phone calls, it is difficult to prove that the assessor has not met their obligations. You should keep copies of all correspondence and note the date, time, and subject of each contact. This documentation is essential if you need to escalate your request to SIRA or seek a review.
A third error is assuming that a change of assessor will automatically result in a better outcome. The new assessor will still be employed by the same insurer and must follow the same legal and policy requirements. They are not required to overturn previous decisions simply because they are different. The claim will still be assessed under the Motor Accident Injuries Act 2017 and the Motor Accident Injuries Regulation 2017.
How to Legally Request a Change of Assessor
You may request a change of assessor at any time during your claim. The process is not governed by a formal application form, but you must submit your request in writing to the insurer. It is best to send the request via email or registered post to ensure you have proof of submission.
Your request should include:
- A clear statement that you are requesting a change of assessor
- The name and contact details of your current assessor
- A detailed explanation of why you believe a change is necessary, including specific examples such as delays in processing, lack of communication, or perceived bias
- Any supporting evidence, such as copies of unanswered emails, missed appointments, or correspondence showing a pattern of non-responsiveness
SIRA guidance states that insurers must consider such requests and respond within a reasonable time. However, they are not required to approve the change. If your request is denied, you may ask the insurer to provide written reasons for the decision.
When to Challenge an Improper Assessor Change
An insurer may change your assessor without your consent, particularly if they are reassigning staff due to workload, internal review, or a change in claim management. This is not necessarily a mistake, but it can be a concern if it happens without notice or if it results in a deterioration in service.
If you believe the change has been made in bad faith, or if it appears to be a way to delay your claim or avoid responsibility, you may have grounds to challenge it. For example, if the insurer changes your assessor immediately after you raise a formal complaint, this may suggest retaliation. In such cases, you can contact SIRA to raise a concern about the insurer’s conduct.
SIRA does not have the power to order a change of assessor, but it can investigate whether the insurer has breached its obligations under the MAIA. If SIRA finds that the insurer failed to act in good faith, it may require them to take corrective action, including reassigning a new assessor.
Practical Steps and Evidence to Preserve
To protect your rights and avoid common pitfalls, you should:
- Keep a written record of all communications with your assessor and insurer
- Save copies of all emails, letters, and notes from phone calls
- Document any delays in receiving benefits, arranging medical assessments, or getting responses to your questions
- Maintain a log of all appointments, including those that were missed or rescheduled
- If you are not satisfied with the insurer’s response to your request, contact SIRA through their online portal or by phone
These steps are not just about protecting your claim, they are essential to proving that the assessor has not met their obligations under the law.
What to Do If Your Request Is Denied
If your request for a change of assessor is denied, you are not without options. You can:
- Ask the insurer to provide a written explanation for the decision
- Contact SIRA to discuss your concerns
- Request a review of your claim by an independent claims reviewer, if available
SIRA provides guidance on how to escalate a dispute, including how to submit a formal complaint. You can access this information through the SIRA website under the ‘Making a claim’ section.
Hypothetical Example: When a Change Was Justified
A 38-year-old woman was involved in a motor accident in Sydney in March 2025. Her CTP insurer assigned a claims assessor who failed to respond to her emails for over six weeks, despite her requesting a medical assessment and a review of her weekly income payment. After sending a formal letter outlining the delays, she was informed that her assessor had been reassigned to another case. She then submitted a written request for a change, citing the lack of communication and the impact on her ability to access treatment. SIRA later confirmed that the insurer had failed to meet its obligations under the MAIA, and the claim was reassigned to a new assessor within two weeks.
This example shows that a change of assessor is not automatic, but it can be justified when there is a pattern of failure to act in good faith.
Next Steps: Protect Your Claim
The process of changing your CTP claims assessor is not a simple administrative task. It requires clear communication, evidence, and an understanding of your rights under NSW law. Mistakes such as failing to document issues, making emotional requests, or assuming that a new assessor will fix everything can hinder your claim.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.