If you're involved in a motor accident in NSW and your CTP insurer wants to change the assessor or case manager, you need to understand your rights under SIRA's rules. This article explains how SIRA handles assessor changes on the Central Coast, the legal framework governing these requests, and practical steps to take.
How SIRA Handles Assessor Changes
Under the Motor Accident Injuries Act 2017, CTP insurers must follow SIRA guidelines when managing claims. If your insurer proposes a new assessor, they must provide a written explanation for the change. SIRA’s rules state that insurers cannot unreasonably delay or refuse a request to change assessors, especially if the claimant believes the current assessor has conflicts of interest or is not providing adequate care.
Insurers are required to consider any written request for a new assessor within 14 days. If they refuse the request, they must provide specific reasons, such as the assessor being unavailable or the claim being too complex. Claimants should keep copies of all correspondence and note any delays in the insurer’s response.
Practical Steps for Claimants
If your insurer wants to change the assessor, take the following steps:
- Request a written explanation from the insurer detailing why the change is necessary.
- Check for conflicts of interest, ensure the new assessor has no ties to the insurer or the opposing party.
- Seek independent medical advice if you believe the assessor’s report is incomplete or biased.
- Document all communication with the insurer, including dates and details of any delays.
SIRA’s guidelines also emphasize that claimants have the right to challenge an insurer’s decision to change assessors. If the insurer’s actions appear to be delaying your claim or affecting the quality of your care, you may need to escalate the issue to SIRA.
Time Limits and Dispute Options
CTP insurers must act within strict timeframes. For example, if your claim involves weekly income payments or treatment benefits, the insurer must provide an initial assessment within 28 days of the claim being reported. Delays in assessor changes could affect your entitlements, especially if your injury requires ongoing care.
If you believe the insurer is not following SIRA’s rules, you can:
- Submit a formal complaint to SIRA’s Customer Service team.
- Request a review of the assessor’s report through the NSW Civil and Administrative Tribunal (NCAT).
- Seek legal advice if the insurer’s actions are causing significant delays or affecting your compensation.
When to Seek Legal Advice
While SIRA provides clear guidelines, interpreting them correctly can be complex. For example, if your insurer claims the new assessor is ‘more experienced’ but this is not supported by evidence, you may need a solicitor to challenge the decision. Legal advice is also recommended if the insurer refuses to provide a written explanation for the assessor change.
Example Scenario
Imagine you’ve been injured in a car accident and your insurer has appointed an assessor. After several months, they request a new assessor, claiming the original one is ‘too busy.’ Under SIRA’s rules, the insurer must justify this change. If they fail to provide a valid reason, you may have grounds to dispute the decision.
Next Steps
CTP entitlements depend on the date of your accident, the nature of your injury, and the insurer’s actions. To ensure your rights are protected, complete the quick, no obligation enquiry form to discuss your circumstances with a legal professional.