Delayed Insurer Decisions, What You Can Do in NSW
If your CTP claim in Greater Sydney has been delayed by an insurer, you have formal options to seek resolution. The Motor Accident Injuries Act 2017 (MAIA) and the Motor Accident Injuries Regulation 2017 set out the legal framework for handling delays, and the State Insurance Regulatory Authority (SIRA) oversees dispute resolution. An insurer must assess your claim within a reasonable time, but delays may occur due to incomplete information, medical assessment backlogs, or internal review processes. You are not required to accept a delayed decision without action. The available dispute resolution pathways are designed to ensure claims are processed fairly and within a reasonable timeframe.
Legal Framework for CTP Claim Disputes
Under the MAIA, insurers are required to assess a claim and notify the claimant of their decision within a reasonable time. There is no fixed statutory timeframe for a decision, but delays that are unreasonably long may be challenged. The SIRA is the independent body responsible for overseeing CTP claims in NSW and has authority to resolve disputes. If an insurer fails to make a decision, or if you disagree with the outcome, you may apply to SIRA for a determination. This process is not a court proceeding, but it carries legal weight and can result in a binding decision.
Practical Steps to Address a Delayed Decision
If your insurer has not made a decision on your CTP claim, act promptly. First, confirm that all required documentation has been submitted, including medical reports, accident details, and any correspondence. If the insurer has not responded within a reasonable period, typically more than 30 days after submitting a complete claim, you should formally request a written update. Keep a record of all communications. If the insurer still does not respond, you may escalate the matter to SIRA. SIRA provides a formal dispute resolution pathway for claimants who believe their claim has been unreasonably delayed.
SIRA’s Role in Resolving CTP Disputes
SIRA can review a claim that has been delayed and determine whether the insurer’s actions were reasonable. You may apply to SIRA for a determination if you believe the insurer has failed to act within a reasonable time. SIRA will assess whether the insurer had a valid reason for the delay, whether the claim was complete, and whether the insurer followed proper procedures. SIRA may also require the insurer to provide a written explanation for the delay. If SIRA finds the delay was unreasonable, it may order the insurer to make a decision, pay for medical treatment, or provide compensation.
Internal Review and Medical Dispute Pathways
Before approaching SIRA, you may request an internal review from the insurer. This is not mandatory, but it allows the insurer to reassess the claim based on new or additional information. If you have received a medical assessment that contradicts the insurer’s view, you may also initiate a medical dispute under the Personal Injury Commission (PIC) process. The PIC handles disputes over medical evidence, including assessments of impairment, treatment needs, and injury causation. A medical dispute does not automatically change the insurer’s decision, but it provides an independent review of clinical evidence. You must provide a full medical record, including reports from your treating medical practitioner, to support your case.
Evidence That Matters in Dispute Resolution
The strength of your dispute depends on the quality and completeness of your evidence. Key documents include:
- A detailed medical report from your treating practitioner, including diagnosis, treatment plan, and prognosis
- Photographic evidence of the accident scene or vehicle damage
- A written statement from a witness, if available
- A copy of the police report, if one was filed
- Records of lost income, if applicable
- All correspondence with the insurer, including emails and letters
Ensure that medical evidence clearly links your injuries to the motor accident. SIRA and insurers will assess whether the injury was caused by the accident and whether treatment is reasonable and necessary.
Time Limits and Procedural Requirements
While there is no fixed deadline for an insurer to decide on a CTP claim, delays that exceed a reasonable period may be challenged. SIRA does not set a strict time limit for applying, but it is advisable to act within 12 months of the accident or when the delay becomes apparent. If you have not received a decision after 60 days from submitting a complete claim, you should consider escalating the matter. A claim may still be valid if you apply to SIRA within a reasonable timeframe, but delays in initiating a dispute may affect the outcome.
Hypothetical Example: A Delayed Decision in Sydney
A pedestrian in Sydney was struck by a car in a car park on 15 May 2026. They sustained a back injury and were treated by a specialist. The claim was submitted to the insurer on 10 June 2026, but no decision was received by 15 August 2026. The claimant contacted the insurer twice and received no response. The claimant then submitted a formal request to SIRA for a determination, including medical reports, a witness statement, and a copy of the initial claim. SIRA reviewed the case and found the delay was unreasonable. It directed the insurer to make a decision within 21 days and to cover the cost of a follow-up assessment. The insurer complied.
When to Seek Independent Advice
A delay in decision-making does not mean your claim will be denied. However, it may indicate a need for independent review. If you are uncertain about your rights, the strength of your evidence, or the best way to proceed, you should seek advice from a qualified professional. SIRA provides information and guidance, but it does not represent claimants. An independent advisor can help you understand your options, prepare a submission, and ensure your rights are protected.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.