If your CTP insurer is delaying a decision on your motor accident claim, time is critical. Under NSW law, injured road users have specific rights and time limits to pursue compensation. This article explains your options when insurers fail to act promptly, based on SIRA guidelines and the Motor Accident Injuries Act 2017.
Why Delayed Decisions Matter
CTP insurers must respond to claims within set timeframes. Delays can disrupt your access to essential benefits like weekly payments or treatment coverage. SIRA guidance (https://www.sira.nsw.gov.au/claims/motor-accidents) states insurers must acknowledge claims within 14 days and provide a decision within 28 days for straightforward cases. If your insurer misses these deadlines, you may have grounds to escalate the matter.
Practical Steps for Injured Road Users
- Document the delay - Keep records of all correspondence, including dates of phone calls, emails, and letters. Note any promises of a timeline.
- Request written confirmation - Ask the insurer to confirm their decision timeline in writing. This creates a paper trail.
- Submit medical evidence promptly - Ensure your treating doctor provides a report detailing your injuries and how they impact your daily life. SIRA requires medical evidence to assess claim validity.
- Check for statutory benefits - If your injury meets the threshold injury definition (soft tissue injuries with neurological signs), you may be eligible for weekly payments under the Motor Accident Injuries Act 2017.
- Seek legal advice if delays exceed 52 weeks - After 52 weeks, weekly benefits typically stop unless your injury meets the whole person impairment threshold. Delays beyond this period may affect your entitlements.
How SIRA Guidance Applies
SIRA’s Making a motor accident claim page (https://www.sira.nsw.gov.au/claims/motor-accidents/making-a-claim) outlines that insurers must provide a written decision within 28 days. If your claim involves complex medical assessments, the insurer must notify you of the delay and provide a revised timeline. Failure to comply may constitute a breach of duty.
What to Do If Your Claim Is Stuck
If your insurer refuses to act, you can escalate the matter through SIRA’s dispute resolution process. Under the Motor Accident Injuries Act 2017, you may also apply to the NSW Civil and Administrative Tribunal (NCAT) for a review. Always keep copies of all communications and evidence.
Example Scenario
Imagine a Balmain pedestrian injured in a car accident. The insurer delays acknowledging the claim for 21 days, missing the 14-day deadline. The injured person submits medical records showing a soft tissue injury with radiculopathy (a neurological sign), qualifying for weekly payments. However, the insurer delays the decision for 52 weeks, after which benefits stop. In this case, the injured person must act quickly to challenge the delay and seek legal advice.
When to Seek Help
If your insurer’s delay disrupts your access to treatment, income support, or other benefits, contact a legal professional. While this article provides general guidance, your circumstances may require tailored advice. Time limits for claims and disputes are strict, so act promptly.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.