Understanding the Change of Assessor in CTP Disputes
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 a CTP insurer changes your claims assessor during a dispute in Armidale, NSW, it is typically part of the insurer’s internal process to manage claims. The Personal Injury Commission (PIC) does not directly oversee or approve changes in assessors. However, the PIC expects that any change must not disrupt the claimant’s access to fair and timely assessment of their injury and entitlements under the Motor Accident Injuries Act 2017.
A change of assessor may occur if the original assessor is unavailable, if a conflict of interest arises, or if a review of the claim’s progress indicates a need for a different approach. The PIC expects that the new assessor must be qualified, independent, and able to continue the assessment process without delay. The claimant must be notified in writing of the change, including the name and contact details of the new assessor.
What the PIC Expects from Insurers and Claimants
The PIC expects CTP insurers to act in good faith and to maintain transparency when changing assessors. Insurers must ensure that the new assessor receives all relevant documentation, including medical reports, treatment records, and prior assessment notes, to avoid gaps in the claim process.
The PIC also expects claimants to cooperate with the new assessor. This includes attending medical assessments, providing updated medical evidence, and responding to requests for information within a reasonable timeframe. Failure to engage with the new assessor may delay the claim and could affect the outcome of any dispute.
Practical Steps to Take After a Change of Assessor
If your CTP insurer changes your assessor, you should:
- Confirm in writing that the new assessor has been appointed and request a copy of the notification.
- Review the new assessor’s qualifications and experience, particularly in relation to your injury type.
- Provide any updated medical evidence, including recent treatment notes, imaging reports, or assessments from your treating medical practitioner.
- Keep a record of all correspondence with the new assessor, including emails, letters, and notes from phone calls.
- If you believe the change is being used to delay or frustrate your claim, you may request a review of the insurer’s conduct from the PIC.
Evidence That Matters in Disputes
The PIC relies on objective evidence to assess whether a claim is being managed fairly. Relevant evidence includes:
- Medical reports from treating practitioners, including assessments of your injury, recovery progress, and capacity for work.
- A record of all communications with the insurer and assessors, including dates, subjects, and responses.
- Photographs of the accident scene, vehicle damage, or injury-related symptoms, if available.
- A copy of the original accident report, if filed with police or a workplace incident report.
If your injury involves a spinal nerve-root injury, the PIC will expect that neurological signs (other than radiculopathy) are documented in accordance with the Motor Accident Guidelines. This is critical if your claim involves a threshold injury and you are seeking damages.
Time Limits and Dispute Pathways
There is no fixed time limit for a CTP insurer to change an assessor. However, delays in notifying you of the change or in transferring case files may be considered by the PIC if they impact your ability to progress the claim.
If you believe the change of assessor has caused a delay or an unfair outcome, you may request a review through the PIC’s dispute resolution pathway. This includes:
- Internal review by the insurer within 21 days of receiving a dispute notice.
- Application to the Personal Injury Commission for a formal review, which may involve a medical dispute assessment under the Motor Accident Injuries Act 2017.
A medical dispute assessment is available if there is a disagreement about the nature or extent of your injury. The PIC will appoint a qualified medical practitioner to assess your condition independently. This process is not automatic and must be formally requested.
Hypothetical Example: A Claimant in Armidale
A pedestrian in Armidale was struck by a car in June 2024. The CTP insurer initially assigned an assessor who was not experienced in spinal injuries. After the claimant submitted a report from a neurologist confirming a spinal nerve-root injury with neurological signs, the insurer changed the assessor. The new assessor did not review the neurologist’s report before scheduling a medical assessment. The claimant contacted the PIC, which required the insurer to provide the full file to the new assessor and to justify the delay. The PIC later found that the change had not been properly managed, and the insurer was directed to resume processing the claim within 14 days.
When to Seek Independent Advice
A change of assessor does not automatically mean your claim is being mishandled. However, if you believe the change is being used to delay or undermine your claim, or if the new assessor fails to respond to your evidence, you should seek independent advice.
The PIC does not represent claimants. It only reviews insurer conduct and assesses whether the claim has been managed fairly under the Motor Accident Injuries Act 2017 and the Motor Accident Guidelines.
Next Steps
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.