If a CTP insurer replaces your treatment assessor or case manager, it can disrupt your rehabilitation plan. Under NSW law, insurers may change assessors if they believe the current one is unsuitable for your claim. This article explains when such changes are allowed, how they impact your care, and steps to challenge unfair replacements. SIRA oversees disputes over assessor changes in CTP claims.
When Can a CTP Insurer Replace an Assessor?
CTP insurers may replace an assessor if they believe the current one lacks the necessary expertise or if the assessor’s report conflicts with the insurer’s claim management needs. For example, if a new assessor is required to evaluate long-term care needs after a spinal injury, the insurer may request a change. However, insurers must ensure the replacement does not prejudice the claimant’s ability to access appropriate treatment.
How Does an Assessor Change Affect Treatment Planning?
An assessor change can delay or disrupt your rehabilitation plan. The new assessor may require additional time to review your medical records, leading to delays in approving therapies like physiotherapy or occupational therapy. If the change results in a lower treatment plan, you may need to challenge the decision to ensure your care needs are fully addressed.
Steps to Challenge an Unjustified Assessor Change
If you believe an assessor change is unfair, take these steps:
- Document the change: Keep records of all communication with the insurer, including dates and reasons for the replacement.
- Review medical records: Ensure the new assessor has access to all relevant medical evidence, including specialist reports and treatment histories.
- Contact SIRA: The State Insurance Regulatory Authority (SIRA) oversees disputes over assessor changes. You can request a review of the insurer’s decision through SIRA’s mediation process.
How SIRA Handles Assessor Change Disputes
SIRA evaluates whether the insurer’s replacement of an assessor is reasonable. The regulator considers factors such as the assessor’s qualifications, the insurer’s claim management needs, and whether the change impacts your access to treatment. If SIRA finds the change was unjustified, the insurer may be required to revert to the original assessor or provide a new one.
Practical Example
Consider a claimant with a soft-tissue injury who is being assessed by a physiotherapist. The insurer replaces the assessor with a different physiotherapist to evaluate long-term mobility needs. If the new assessor delays treatment or reduces the scope of care, the claimant can request SIRA to review the change. SIRA will assess whether the replacement was necessary and whether the claimant’s treatment plan remains adequate.
Time Limits and Next Steps
CTP insurers must act within the legal timeframe to manage claims, but there is no specific deadline for replacing assessors. If you believe an assessor change is impacting your recovery, seek advice promptly. Contact SIRA directly or consult a legal professional to explore your options.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.