Delayed CTP insurer decisions in Armidale: what to do
If your CTP insurer in Armidale has not made a decision on your claim within a reasonable time, you may have formal options to seek resolution. The Motor Accident Injuries Act 2017 and the Motor Accident Injuries Regulation 2017 set out the legal framework for handling delays. You are not required to wait indefinitely. The insurer must assess your claim and respond within a timeframe that reflects the complexity of your case, but delays beyond what is reasonable may be challenged. The process for dispute resolution is available across NSW, including in Armidale, and does not require you to have a lawyer to begin.
Legal framework for delayed decisions
Under the Motor Accident Injuries Act 2017, insurers are required to assess claims and provide a decision within a reasonable time. While the Act does not define a fixed timeframe for every claim, it establishes that a delay may be considered unreasonable if it prevents you from receiving necessary benefits such as treatment and care, weekly income payments, or a determination on your entitlement to damages. The insurer must notify you of the decision in writing, and if they fail to do so, you may proceed to dispute the delay through formal channels. The dispute process is not automatic and must be initiated by the claimant.
Internal review and insurer response
The first step when you believe your insurer’s decision is delayed is to request an internal review. You may write to the insurer, clearly stating that you are seeking a review of the delay in processing your claim. The insurer must respond to your request within 28 days. During this period, you may also request a copy of the insurer’s internal review policy, which must be available on their website or upon request. If the insurer does not respond within 28 days, or if the internal review results in a decision you still find unreasonable, you may escalate the matter to the State Insurance Regulatory Authority (SIRA).
SIRA dispute resolution process
SIRA is the independent body responsible for overseeing CTP claims in NSW. If you have exhausted the internal review process and remain dissatisfied, you may lodge a dispute with SIRA. SIRA provides a formal dispute resolution pathway that includes a review of the insurer’s actions, including whether the delay was unreasonable. You must submit your dispute within 12 months of the insurer’s last communication on your claim, or within 12 months of the date the insurer failed to respond. SIRA may mediate the dispute, or if mediation fails, it may issue a determination. This determination is not binding on the insurer, but it carries significant weight and may result in the insurer being required to pay benefits or change their decision.
Medical evidence and claim support
To strengthen your dispute, you must provide evidence that supports the delay and your ongoing need for benefits. This includes medical records showing treatment for injuries sustained in the accident, a medical practitioner’s report confirming your ongoing impairment or inability to work, and correspondence with the insurer. If your claim involves a dispute over medical treatment, you may also request a medical dispute resolution through the Personal Injury Commission (PIC). The PIC provides an independent assessment of medical evidence and can issue a determination that may be used to challenge the insurer’s position. You must provide a copy of the PIC determination to SIRA if you are pursuing a dispute.
Time limits and procedural requirements
There are time limits that apply to disputing delayed CTP decisions. You must lodge a dispute with SIRA within 12 months of the insurer’s last written response, or within 12 months of the date the insurer failed to respond. Missing this deadline may prevent you from seeking formal resolution. The 12-month period is strict and not extended for delays in receiving documents, unless a court has made an order to extend time. It is essential to keep a record of all communications with the insurer, including emails, letters, and call logs, to establish the timeline of events.
Hypothetical example: Delayed decision in Armidale
A pedestrian in Armidale was struck by a car in April 2025. They reported the injury to the CTP insurer in May 2025 and submitted medical records and a treatment plan. The insurer did not respond to any correspondence until January 2026, nearly 10 months later. The claimant requested an internal review in February 2026 and received no response. They then lodged a dispute with SIRA in March 2026, providing all medical evidence and correspondence. SIRA accepted the dispute and, after review, found the delay was unreasonable. The insurer was required to pay treatment and care benefits from the date of the accident and to reconsider the claim for weekly income payments.
When to seek independent advice
A delay in decision does not automatically mean the insurer is at fault, nor does it guarantee a change in outcome. The dispute process is not a substitute for legal advice, and you should consider speaking with a legal practitioner if your claim involves complex injury, a dispute over damages, or if the insurer has denied benefits. The process can be complex, and a failure to follow the correct steps may result in your dispute being dismissed. You are not required to have a lawyer to begin a dispute, but independent advice may help you understand your rights and improve your chances of a favourable outcome.
Next steps
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.