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).
If your insurer is delaying a decision on your NSW Compulsory Third Party (CTP) claim related to resuming daily activities, you may be entitled to seek resolution. Under the Motor Accident Injuries Act 2017, insurers must process claims within set timeframes, though delays can occur. This article explains how to address delays, what evidence matters, and when to seek legal advice. The focus is on claims involving recovery of daily activities, such as returning to work or managing household tasks, in Ashfield NSW.
What Constitutes a Delayed CTP Decision?
NSW CTP insurers are legally required to respond to claims within 28 days of receiving a completed claim form, per SIRA guidelines. Delays beyond this period may indicate a failure to meet statutory obligations. A 'delayed decision' typically refers to situations where:
- The insurer fails to acknowledge the claim within 28 days
- The insurer takes longer than 28 days to issue a decision
- The insurer requests additional information that is not reasonably necessary
Insurers may justify delays by citing incomplete documentation, but claimants are entitled to a timely response. If your claim is delayed, you may need to escalate the matter.
How Insurers Justify Delays
Common justifications for delays include:
- Requesting additional medical evidence (even when it’s already provided)
- Claiming the claimant hasn’t met 'threshold injury' criteria
- Delaying decisions on weekly income payments or treatment benefits
However, insurers must act within the 28-day timeframe. If they fail to respond within this period, you may have grounds to challenge the delay. SIRA’s guidelines state that claims must be processed 'without unnecessary delay' (SIRA, Making a motor accident claim).
Practical Steps for Claimants
If your insurer is delaying a decision, take these steps:
- Document all communication with the insurer, including dates and correspondence
- Keep copies of medical records showing your ability to return to daily activities
- Request a written explanation for any delays
- Seek mediation through the NSW Civil and Administrative Tribunal (NCAT) if needed
Evidence such as medical reports, accident records, and witness statements can support your case. For example, a doctor’s note confirming you’re ready to return to work but the insurer is delaying weekly income payments could strengthen your claim.
Time Limits and Dispute Options
Under the Motor Accident Injuries Act 2017, you have 52 weeks from the accident date to claim weekly income benefits for threshold injuries. If your claim is delayed beyond this period, you may lose access to these benefits. However, if your injury is above the threshold, you may still pursue a common law damages claim separately.
If your insurer refuses to pay or delays decisions, you can:
- Apply to NCAT for a review of the insurer’s decision
- Seek legal advice to challenge the delay or request compensation for lost income
When to Seek Advice
Delays in CTP claims can affect your ability to access benefits like weekly income payments or treatment benefits. If your insurer is not responding within 28 days or is requesting unnecessary information, you should consult a legal professional. A solicitor can help you:
- Challenge the insurer’s delay
- Request compensation for lost income due to the delay
- Ensure your claim for returning to daily activities is processed fairly
Conclusion
Delays in NSW CTP claims for returning to daily activities can impact your access to benefits. Insurers must respond within 28 days, and you have the right to challenge unreasonable delays. If your claim is delayed, take steps to document the issue and seek legal advice. Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.