Delayed Insurer Decisions and Returning to Daily Activities in Rural NSW
If an insurer in New South Wales delays making a decision about your ability to return to daily activities following a motor accident, it may affect your access to rehabilitation support, treatment and financial assistance. This delay can be particularly challenging in rural and remote areas where medical and support services are less accessible. Under the Motor Accident Injuries Act 2017, insurers are required to assess claims and make decisions about entitlements, including rehabilitation planning, within a reasonable timeframe. However, there is no fixed statutory deadline for insurer decisions, and delays may occur due to incomplete information, complex injury assessments, or administrative backlogs.
Legal Framework for CTP Claims in NSW
Compulsory Third Party (CTP) insurance in NSW provides compensation for injuries resulting from motor vehicle accidents. The Motor Accident Injuries Act 2017 and the Motor Accident Injuries Regulation 2017 set out the legal framework for claims. Insurers must assess whether you are entitled to treatment and care benefits, weekly income payments, or damages. For claims involving a return to daily activities, the insurer must determine whether your injury prevents or limits your ability to perform normal daily tasks, and whether rehabilitation is appropriate.
If you have a threshold injury, such as a soft tissue injury with neurological signs, the insurer must assess whether you meet the threshold for damages. The Motor Accident Guidelines set out the clinical criteria for determining whether an injury qualifies as a threshold injury. Where only threshold injuries are present, entitlement to weekly benefits and treatment and care benefits is generally limited to 52 weeks after the accident, unless a review or dispute arises.
Practical Steps When an Insurer Delays a Decision
If you believe your insurer is delaying a decision, you should take the following steps:
- Contact the insurer in writing to request a written update on the status of your claim.
- Provide any missing documentation, such as medical reports, treatment records, or a completed rehabilitation plan.
- Request a copy of the insurer’s internal claim management process to understand where your claim is in the workflow.
- Seek a review from the insurer’s internal dispute resolution process if no response is received within 30 days.
In rural and remote areas, access to medical practitioners, allied health professionals, and legal advice may be limited. This can delay the provision of medical evidence, which in turn delays insurer decisions. It is important to keep a record of all correspondence, including dates and details of phone calls, and to retain copies of medical reports, accident reports, and photographs of the scene or injury.
Navigating Delays in Rural and Remote NSW
In rural and remote NSW, claimants may face additional challenges due to distance from medical facilities, limited transport options, and reduced availability of specialists. Delays in receiving a decision can disrupt rehabilitation planning, delay access to physiotherapy or psychological support, and impact your ability to return to work or household duties.
If you are unable to access timely medical assessment, you may request that the insurer arrange for an independent medical assessment (IMA) to be conducted at a location closer to you, or via telehealth if appropriate. The insurer must cover reasonable travel and accommodation costs for assessments if they are required.
Dispute Resolution and SIRA’s Role
If your insurer fails to make a decision within a reasonable timeframe, or you disagree with their assessment, you may escalate the matter to the State Insurance Regulatory Authority (SIRA). SIRA provides guidance on dispute resolution and can assist in resolving disagreements about entitlements, including decisions about returning to daily activities.
SIRA’s dispute resolution process is free and can be initiated by you or your legal representative. You may request a review of the insurer’s decision, or ask SIRA to mediate a resolution. SIRA does not determine claims but supports parties in reaching a fair outcome.
Hypothetical Example
A farmer in Wagga Wagga was involved in a motor accident in July 2026. He sustained a soft tissue injury to his neck and back, with documented neurological signs. His insurer delayed issuing a decision on his ability to return to daily activities for over six months, citing the need for further medical evidence. During this time, he was unable to perform farm duties, and his access to a specialist was limited due to distance. After requesting a review and receiving no response, he contacted SIRA, which facilitated a resolution within 10 weeks, resulting in approval for rehabilitation and treatment benefits.
Next Steps and When to Seek Advice
Insurer delays in making decisions about returning to daily activities can have a significant impact on recovery and daily life, particularly in rural and remote NSW. The available options may depend on the facts, evidence and applicable law. Time limits and procedural requirements may apply, especially in relation to disputes and appeals.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.