Delayed Insurer Decisions and Daily Activities in NSW CTP Claims
If an insurer delays deciding whether you can return to daily activities after a motor accident, it can disrupt your recovery and financial planning. Under NSW CTP laws, insurers must assess claims promptly, but delays are not uncommon. This article explains how delayed decisions affect claimants, what steps to take, and how SIRA's guidance applies to daily activity claims on the Central Coast.
How Delayed Decisions Impact Daily Activities
CTP claims cover treatment, income support, and recovery of daily activities like cooking, cleaning, or managing household tasks. Delays in insurer decisions can prevent claimants from accessing benefits that help them regain independence. For example, if an insurer takes weeks to approve a claim for assistance with daily tasks, the claimant may face prolonged financial strain and reduced quality of life.
SIRA's guidance (https://www.sira.nsw.gov.au/claims/motor-accidents/what-you-can-claim) states that claims for daily activities must be supported by medical evidence showing the need for assistance. Delays can occur if insurers request additional documentation or fail to acknowledge the link between the injury and daily activity limitations.
Practical Steps for Claimants Facing Delays
- Document Daily Activity Challenges: Keep a journal of tasks you struggle with, such as preparing meals or personal hygiene. This evidence supports your claim for assistance.
- Request Written Timeframes: Ask the insurer for a written timeline for their decision. Under NSW CTP rules, insurers must respond within a reasonable time, though there is no strict statutory deadline.
- Escalate the Claim: If the insurer fails to act, contact SIRA's claims team or seek legal advice. SIRA's website (https://www.sira.nsw.gov.au/claims/motor-accidents) provides templates for escalating unresolved claims.
- a Seek Medical Confirmation: Ensure your treating doctor documents how the injury affects your ability to perform daily activities. This strengthens your case for benefits like weekly income payments or treatment and care support.
SIRA's Role in Assessing Daily Activity Claims
SIRA evaluates claims based on the Motor Accident Guidelines, which define what constitutes a 'threshold injury' or 'whole person impairment.' For example, if your injury meets the threshold for soft tissue damage (such as a whiplash injury), you may qualify for weekly benefits to cover lost income while recovering daily activities.
If an insurer disputes your claim, SIRA's guidelines require them to provide a detailed explanation of their decision. Delays in this process may indicate a failure to comply with standard assessment procedures.
When to Seek Legal Advice
If your insurer refuses to acknowledge your need for assistance with daily activities or delays decisions for over 60 days, you may need to consult a solicitor. Legal advice can help you challenge delays, request expedited reviews, or pursue compensation for financial losses caused by the insurer's inaction.
Example: A Central Coast Claimant's Experience
Consider a claimant on the Central Coast who sustained a soft tissue injury in a car accident. They documented their inability to prepare meals or manage household tasks for six weeks. The insurer delayed approving their claim for 45 days, during which the claimant faced increased living costs. With legal assistance, the claimant was able to secure weekly benefits to cover these expenses.
Next Steps
CTP claims involving daily activities require timely insurer action to prevent unnecessary hardship. If you're facing delays, take steps to document your needs, request written timeframes, and escalate the issue through SIRA or legal channels. Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.