CTP Insurers Can Replace Assessors During Claims
Under NSW Compulsory Third Party (CTP) rules, insurers may replace claims assessors or case managers if there are legitimate reasons, such as unavailability, conflict of interest, or concerns about the original assessor’s suitability. This process is governed by the Motor Accident Injuries Act 2017 and SIRA guidelines, which emphasize fair treatment of injured claimants.
How Assessor Changes Affect Treatment and Rehabilitation
When an assessor is replaced, the new assessor must reassess the injured person’s treatment and rehabilitation plan. This can delay or disrupt care, especially if the new assessor does not approve essential therapies or treatments. For example, if a claimant requires physiotherapy to regain mobility, a new assessor might delay approval, impacting recovery timelines. SIRA’s guidelines stress that treatment planning must be based on clinical evidence and the injured person’s needs.
Practical Steps for Claimants Facing Assessor Changes
- Request Written Reasoning: Ask the insurer to provide a clear, written explanation for the assessor change, including the basis for the decision. SIRA requires insurers to justify changes under the CTP scheme.
- Review the New Assessor’s Credentials: Ensure the replacement assessor is qualified and has experience in treating injuries similar to yours. SIRA’s website lists accredited assessors and their qualifications.
- Challenge Unreasonable Changes: If the change appears arbitrary or impacts your treatment, you may dispute it through SIRA’s dispute resolution process. This involves submitting a formal objection and supporting evidence, such as medical reports or treatment records.
- Seek Independent Medical Advice: If the new assessor’s recommendations conflict with your doctor’s opinion, obtain a second medical opinion to support your case.
Time Limits and Dispute Options
CTP insurers must respond to disputes within 28 days under SIRA’s rules. If the insurer fails to act within this timeframe, you may escalate the matter to SIRA or seek mediation. For complex cases, the NSW Civil and Administrative Tribunal (NCAT) can resolve disputes about treatment planning or assessor changes.
When to Seek Legal Advice
If the assessor change significantly affects your treatment, delays your recovery, or results in reduced compensation, consult a solicitor. Legal advice can help you challenge the change, request a new assessor, or negotiate a fair outcome under the CTP scheme.
Example: Impact of an Unapproved Assessor Change
Consider a claimant who requires ongoing occupational therapy to return to work. If the insurer replaces the assessor and the new assessor denies approval for therapy, the claimant may face prolonged recovery and lost income. In such cases, evidence like therapy records, medical opinions, and work impact assessments are critical to challenge the decision.
Next Steps
CTP entitlements depend on the accident date, injury type, and claim history. To request contact about your circumstances, complete the quick, no obligation enquiry form.