If your insurer is delaying a decision on your NSW Compulsory Third Party (CTP) claim, you have legal options to resolve the dispute. Under the Motor Accident Injuries Act 2017, insurers must act within set timeframes to assess claims. Delays can disrupt access to benefits like weekly payments or treatment costs. This guide explains how to challenge a delayed decision, including SIRA processes and steps to escalate claims in Western Sydney.
Legal Options for Delayed CTP Claims
Insurers must respond to claims within 28 days of receiving a completed claim form, per SIRA guidelines. If they fail to act within this timeframe, you can:
- Request a written explanation for the delay
- Submit a formal written complaint to the insurer
- Lodge a dispute with the NSW Civil and Administrative Tribunal (NCAT) if the insurer refuses to act
The Motor Accident Injuries Act 2017 s 4.4 limits benefits for claims where injuries are below the 'threshold injury' definition after 52 weeks. Delays in assessing your claim could affect access to these statutory benefits.
SIRA's Role in Dispute Resolution
SIRA oversees CTP claims and provides a structured process for resolving disputes. If your insurer delays a decision, you should:
- Contact SIRA's claims team to confirm the insurer's compliance with timeframes
- Request a copy of the insurer's internal review process
- Submit a written complaint to SIRA if the insurer fails to respond
SIRA's internal review process typically takes 21 days from receipt of a written complaint. If the insurer's delay exceeds this, SIRA may intervene to expedite your claim.
Practical Steps for Claimants
To support your dispute, gather:
- A copy of your claim form and submission date
- Records of all communication with the insurer
- Medical evidence confirming your injury's date and severity
- Evidence of financial impact from delayed benefits
If your claim involves a medical dispute, you can request a review by the Personal Injury Commission (PIC) to assess whether your injury meets the threshold injury definition. This process can take up to 60 days but ensures medical evidence is evaluated by independent experts.
Example Scenario
Consider a claimant who suffered a soft tissue injury in Western Sydney. Their insurer delayed assessing the claim for 35 days, missing the 28-day timeframe. The claimant submitted a written complaint to SIRA, which found the insurer had not followed proper procedures. SIRA expedited the claim, resulting in the claimant receiving weekly benefits within 14 days of the complaint.
When to Seek Legal Advice
If your insurer refuses to act, ignores SIRA guidelines, or disputes your claim on technical grounds, you may need legal assistance. A solicitor can:
- Help you draft formal complaints
- Challenge the insurer's interpretation of the Motor Accident Guidelines
- Represent you at NCAT if the dispute escalates
Time limits apply. You must lodge a dispute with SIRA within 28 days of receiving the insurer's decision. For claims involving medical disputes, you have 60 days from the date of the injury to request a PIC review.
Next Steps
CTP claims depend on the date of the accident, the nature of the injury, and the insurer's actions. If your claim is delayed, act quickly to preserve your rights. Complete the quick, no obligation enquiry form to request contact about your circumstances.