Disputing a Claims Assessor's Decision in NSW CTP Claims
If you have been involved in a motor accident in New South Wales and disagree with a claims assessor's decision about your compensation, you have formal options to challenge it. The Motor Accident Injuries Act 2017 (MAIA) governs the CTP scheme, and assessors are appointed to determine entitlements to statutory benefits and damages. Their decisions are not final, and you may seek review through SIRA or the Personal Injury Commission. This article explains the legal process for disputing an assessor’s decision, the limits of their authority, and the practical steps to take in Greater Sydney.
Role and Authority of Claims Assessors
Claims assessors are independent professionals appointed under the MAIA to assess motor accident claims in NSW. Their role is to determine whether a claimant is entitled to statutory benefits, including weekly income payments and treatment and care benefits, and whether injuries meet the legal threshold for damages.
Assessors must follow the Motor Accident Guidelines and apply the definitions in the MAIA. For example, a threshold injury includes a soft tissue injury that results in a spinal nerve-root injury producing neurological signs other than radiculopathy. This means that even if there is no nerve root irritation, a neurological sign such as altered reflexes or muscle weakness may still qualify.
Assessors have no power to award damages beyond statutory benefits. Their decisions are not binding and may be reviewed or overturned by SIRA or the Personal Injury Commission.
Dispute Resolution Pathways
If you disagree with a claims assessor’s decision, you may pursue one of two formal review pathways under the MAIA.
#### Internal Review by SIRA
You may request an internal review of the assessor’s decision by submitting a written objection to SIRA. This process allows SIRA to reassess the claim, including reviewing medical evidence and the application of the Motor Accident Guidelines.
To request an internal review:
- You must submit your objection within 28 days of receiving the assessor’s decision
- The review must be in writing and clearly state the grounds for dispute
- SIRA may appoint a new assessor to re-examine the claim
The internal review process typically takes four to six weeks. If the review results in a change, you will be notified in writing.
#### External Review by the Personal Injury Commission
If the internal review does not resolve the dispute, you may apply for an external review by the Personal Injury Commission. This body has the authority to review the legal correctness of the assessor’s decision and may overturn or amend it.
To qualify for external review:
- The claim must have undergone an internal review by SIRA
- You must have received written notification of the internal review outcome
- You must submit your request for external review within 28 days of that notification
The Personal Injury Commission will assess whether the assessor followed the correct legal process, applied the Motor Accident Guidelines accurately, and made a decision that is supported by the evidence.
Practical Steps to Take
If you wish to dispute a claims assessor’s decision, act promptly and gather the following evidence:
- All medical records, including imaging reports and specialist assessments
- The original accident report and any police or witness statements
- Correspondence with the insurer and the claims assessor
- A copy of the assessor’s decision and any internal review outcome
You must submit your request for internal review within 28 days. Missing this deadline may prevent you from accessing further review options.
If you believe the assessor’s decision is based on a misinterpretation of medical evidence, you may obtain an independent medical report to support your case. This can be particularly important if the assessor relied on a report that contradicts your current condition.
When to Seek Legal Advice
A claims assessor’s decision may be complex, particularly where injury thresholds, medical evidence or statutory benefits are in dispute. If you are uncertain about your rights or how to proceed, it is advisable to consult a solicitor.
A legal practitioner can help you:
- Understand whether your injuries meet the threshold for statutory benefits
- Prepare a written objection or review application
- Interpret the Motor Accident Guidelines and assess whether the assessor applied them correctly
- Represent you in the review process, if required
Legal advice is not required to make a review application, but it may improve your chances of a favourable outcome, especially in contested cases.
Important Limitations on Benefits
Under the MAIA, if a claimant’s only injuries resulting from the motor accident are threshold injuries, weekly payments and treatment and care benefits generally cease after 52 weeks. This applies regardless of ongoing symptoms, unless a new injury or a change in condition is established.
This 52-week limit is not a cap on damages. It only affects statutory benefits. If a claimant later meets the whole person impairment threshold (10% or more), they may become eligible for damages, but only if the injury was not previously assessed as a threshold injury.
Conclusion
A claims assessor’s decision in a NSW CTP claim is not final. You may challenge it through an internal review by SIRA or an external review by the Personal Injury Commission. The process is time-limited, and missing a deadline may close your claim permanently. The outcome depends on the facts, medical evidence, and correct application of the MAIA and Motor Accident Guidelines. Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.