When Can a CTP Insurer Replace an Assessor in NSW?
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).
Under NSW law, a CTP insurer may replace an assessor if they believe the current assessor is not providing accurate or complete information about a claimant’s treatment and rehabilitation needs. This process is governed by the Motor Accident Injuries Act 2017 (MAIA) and SIRA’s guidelines. Insurers must have a legitimate reason to request a change, such as concerns about the assessor’s independence or the need for a more detailed evaluation of long-term care requirements.
How Does an Assessor Change Impact Treatment Planning?
A change in assessors can disrupt treatment and rehabilitation planning by altering the scope of care recommended or delaying decisions about ongoing support. For example, a new assessor might identify additional treatment needs or adjust the expected recovery timeline, which could affect access to weekly income payments or treatment benefits. Claimants should monitor how these changes influence their care plan and ensure their medical team is aware of any new assessments.
Steps to Challenge an Unjustified Assessor Change
If a claimant believes an assessor change is improper, they can:
- Request a written explanation from the insurer detailing the reason for the change
- Challenge the decision through SIRA’s dispute resolution process
- Seek independent medical opinions to support their case
SIRA requires insurers to provide evidence that the change is necessary for accurate claim assessment. Claimants should document all communication and keep copies of any new assessment reports.
SIRA’s Role in Regulating Assessor Changes
SIRA oversees the CTP claims process and ensures insurers follow the MAIA’s requirements. While SIRA does not directly intervene in assessor changes, it provides guidelines on what constitutes a valid reason for a replacement. Claimants can refer to SIRA’s Motor Accident Claims page for details on how to escalate disputes or request a review of an insurer’s decision.
Practical Considerations for Claimants
- Medical Records: Ensure your treating doctors are aware of any new assessor input, as this may affect treatment recommendations.
- Accident Reports: Keep detailed records of all communication with insurers and assessors.
- Time Limits: While there is no fixed deadline for changing assessors, delays in resolving disputes could impact access to benefits after 52 weeks, as outlined in the MAIA.
Example Scenario
A claimant with a soft-tissue injury (threshold injury) may see their treatment plan altered if a new assessor identifies additional spinal nerve-root issues. This could extend their eligibility for weekly income payments beyond the initial 52-week period. Claimants should seek clarification from their medical team and SIRA if they believe the change affects their long-term care needs.
Next Steps
CTP entitlements depend on the accident date, injury type, and claim history. If you’re concerned about an assessor change affecting your treatment or benefits, contact a legal professional to review your case. Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.