When Can a CTP Insurer Change an Assessor?
Under NSW CTP rules, insurers may request a change of assessor if there is a conflict of interest, the current assessor is unavailable, or the claimant’s treatment plan requires a different specialist. The Motor Accident Injuries Act 2017 (s 4.4) and SIRA guidelines state insurers must ensure assessors are qualified to evaluate the claimant’s injuries and rehabilitation needs. For regional NSW claimants, this process can affect access to timely treatment planning.
How Does an Assessor Change Impact Treatment Planning?
A change in assessors may delay or alter the rehabilitation plan, especially if the new assessor identifies different treatment needs. For example, if a claimant in regional NSW is referred to a specialist for a soft-tissue injury, a new assessor might recommend a different therapy or extend the treatment period. This can affect weekly income payments and treatment benefits under the CTP scheme. SIRA advises claimants to document any changes and request written explanations from insurers.
Practical Steps for Regional NSW Claimants
- Request Written Reasoning: If an insurer changes the assessor, ask for a written explanation of why the change is necessary. This helps challenge decisions under the CTP scheme.
- Seek Clarification on Rehabilitation Plans: Ensure the new assessor’s plan aligns with your medical records and treatment history. Discrepancies may require a review by SIRA.
- Contact SIRA Directly: Regional claimants may face delays in accessing assessors. SIRA’s regional offices can mediate disputes and ensure compliance with CTP guidelines.
SIRA’s Role in Overseeing Assessor Changes
SIRA oversees all CTP claims and ensures insurers follow the Motor Accident Guidelines. If a claimant believes an assessor change is unfair or impacts their treatment planning, they can submit a formal complaint to SIRA. The authority has the power to review the decision and direct insurers to revert to the original assessor if the change is not justified.
Example: Regional Claimant’s Experience
Consider a claimant in regional NSW who sustained a soft-tissue injury. Their initial assessor recommended a 12-week treatment plan. When the insurer changed the assessor, the new plan extended to 24 weeks, citing ‘additional neurological signs.’ The claimant disputed this, arguing the change was unnecessary. SIRA reviewed the case and found the new assessor’s findings were not supported by the medical records, leading to a revised plan.
Time Limits and Dispute Options
CTP insurers must act within the 52-week statutory benefit period for threshold injuries. If a claimant believes an assessor change violates this timeframe or affects their benefits, they can request a review through SIRA. Disputes must be resolved within 28 days of the claimant’s written objection, per SIRA’s internal procedures.
Next Steps for Claimants
If your CTP claim involves an assessor change, document all communications with the insurer and seek clarification on how the change affects your treatment plan. Regional claimants may need to engage with SIRA’s local office to ensure their rights under the CTP scheme are upheld. Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.