How SIRA Handles Changes to CTP Assessors in NSW
Where a person's only injuries resulting from the accident are threshold injuries, weekly benefits and treatment and care generally cease after 52 weeks (ss 3.11 and 3.28).
If your CTP claim is reassigned to a new assessor, understanding the rules is critical. Under the Motor Accident Injuries Act 2017 (MAIA), insurers must provide claimants with a fair opportunity to challenge assessor decisions. SIRA, the NSW authority overseeing CTP claims, outlines specific procedures for managing assessor changes. This article explains the legal framework, practical steps, and when to seek advice.
Legal Rules Governing Assessor Changes
CTP insurers cannot unilaterally replace assessors without justification. Section 33 of the MAIA requires insurers to provide claimants with a written explanation for any changes. If an insurer replaces an assessor, they must:
- Offer a written reason for the change
- Allow the claimant to request a review of the new assessor's findings
- Ensure the new assessor has the necessary expertise to evaluate the claim
SIRA's guidelines (https://www.sira.nsw.gov.au/claims/motor-accidents) state that insurers must act reasonably when changing assessors. If a claimant believes the change is unfair or prejudicial, they can request a formal review.
Practical Steps for Claimants
When an assessor change occurs, take these steps:
- Request a written explanation from the insurer detailing why the change is happening
- Ask for a copy of the new assessor's report or notes
- Seek clarification on how the change might affect your claim's outcome
- Consider submitting a formal objection if the change appears unreasonable
Keep all correspondence with the insurer and note any delays or inconsistencies. SIRA's 'Making a motor accident claim' page (https://www.sira.nsw.gov.au/claims/motor-accidents/making-a-claim) provides templates for disputing assessor decisions.
Time Limits and Dispute Options
CTP claimants have 52 weeks from the accident date to challenge certain decisions under the MAIA. If an assessor change occurs after this period, it may limit your ability to contest the decision. SIRA's 'What you can claim' page (https://www.sira.nsw.gov.au/claims/motor-accidents/what-you-can-claim) outlines the timeframe for disputing specific types of claims.
If you disagree with the insurer's actions, you can:
- Submit a formal objection to the insurer
- Request a review from SIRA's internal dispute resolution process
- Seek independent legal advice if the issue isn't resolved
When to Seek Advice
Assessor changes can significantly impact the outcome of your claim. If you're unsure whether the change is justified, or if you need help challenging the decision, it's important to seek legal advice. A solicitor can help you:
- Assess whether the change is lawful under the MAIA
- Prepare a formal objection to the insurer
- Navigate SIRA's dispute resolution process
Example Scenario
Consider a claimant who was reassigned to a new assessor after their original report was delayed. The insurer claims the new assessor has 'greater expertise' but fails to provide evidence for this. In such cases, the claimant can request the insurer to justify the change and ask for a review of the new assessor's findings.
Next Steps
CTP entitlements depend on the accident date, injury type, and claim history. If you're unsure how an assessor change affects your case, contact a legal professional for advice. General information cannot determine whether a claim is available in an individual case. Complete the quick, no obligation enquiry form to request contact about your circumstances.