Delayed Insurer Decisions and Daily Activities in NSW CTP Claims
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, it could affect your ability to return to daily activities. Under NSW law, CTP claims are about injuries, not fault, and insurers must assess claims promptly to determine entitlements. Delays in decisions can create uncertainty about your recovery timeline, treatment options, and financial support.
NSW CTP Rules Behind Delayed Decisions
The Motor Accident Injuries Act 2017 governs CTP claims in NSW. Insurers must assess claims within set timeframes, though the exact deadline depends on the claim type. For example, weekly income payments and treatment benefits are subject to a 52-week limit if only threshold injuries are involved (s 4.4). Delays in insurer decisions can disrupt your ability to access these benefits, especially if your recovery timeline is unclear.
SIRA (State Insurance Regulatory Authority) guidelines emphasize that insurers must act reasonably and promptly. If your insurer delays assessing your ability to return to daily activities, it may impact your claim for treatment and care benefits, which are designed to support your recovery. Delays could also affect your ability to claim compensation for lost income or additional care needs.
Practical Steps for Claimants
If your insurer is slow to decide, take these steps:
- Document your daily activities: Keep a journal of your ability to perform routine tasks, such as cooking, shopping, or working. This helps insurers assess your recovery.
- Preserve medical records: Ensure your treating practitioner documents your progress, as this is critical evidence for your claim.
- Request written timelines: Ask your insurer for a clear timeline for their decision. If they fail to respond within a reasonable time, you may need to escalate the matter.
- Seek independent advice: A legal professional can help you understand your options if your insurer’s delays are affecting your recovery.
Time Limits and Dispute Options
NSW CTP claims must be made within a reasonable time after the accident, though there is no strict statutory deadline. However, delays in insurer decisions can create practical issues. For example, if your insurer delays approving treatment benefits, you may miss out on financial support during your recovery.
If your insurer refuses to act, you may need to escalate the matter through SIRA or seek legal advice. SIRA’s guidelines state that insurers must act reasonably and in good faith, and delays that prevent claimants from accessing benefits may be considered unreasonable.
Example: How Delays Affect Recovery
Consider a claimant who suffered a soft-tissue injury (threshold injury) after a car accident in Balmain. Their insurer delays assessing whether they can return to work. During this time, the claimant may struggle to afford necessary treatments or lose income. Under the Motor Accident Guidelines, the insurer must determine if the injury meets the threshold for benefits. Delays in this assessment can disrupt the claimant’s ability to access support.
When to Seek Legal Advice
If your insurer’s delays are impacting your recovery or financial stability, consider contacting a legal professional. While this article provides general information, your circumstances may require tailored advice. Every claim depends on its own facts, and legal professionals can help you understand your options.
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