If an insurer delays a decision on your NSW Compulsory Third Party (CTP) claim, you need to act quickly to protect your rights. Delayed decisions can affect your access to benefits like weekly payments or treatment costs. This article explains your legal options, practical steps to take, and how SIRA’s guidelines apply to delayed claims.
NSW CTP Rules Behind Delayed Decisions
Under the Motor Accident Injuries Act 2017, insurers must respond to claims within set timeframes. SIRA (State Insurance Regulatory Authority) oversees claims processing and provides guidelines for resolving disputes. If an insurer fails to act promptly, it may breach its duty to assess claims fairly. SIRA’s rules state that claims must be reviewed within 28 days of submission, though this can vary depending on the complexity of the case.
Practical Steps for Injured Road Users
- Document the Delay: Keep records of all communications with the insurer, including dates, times, and details of conversations. Note any delays in receiving a decision letter.
- Contact the Insurer in Writing: Send a formal request for an update, referencing the claim number and referencing SIRA’s guidelines. This creates a paper trail.
- Escalate to SIRA: If the insurer does not respond within 14 days, you can escalate the matter to SIRA. SIRA’s website provides a form to report delays or disputes.
- a Seek Medical Evidence: Ensure your injuries are documented by a medical practitioner. SIRA’s guidelines state that claims must be supported by medical records to confirm injuries.
- Preserve Accident Evidence: Keep photos of the accident scene, witness details, and any accident reports. These can support your claim if the insurer disputes the injury’s severity.
Time Limits and Dispute Options
Under the Motor Accident Injuries Act 2017, you have 52 weeks from the accident date to claim weekly benefits for threshold injuries. If the insurer delays beyond this period, you may lose access to certain payments. However, you can still pursue treatment and care benefits for longer. If the insurer disputes your claim, you can request a review through SIRA or seek independent legal advice. SIRA’s guidelines also allow for disputes to be resolved through mediation before formal legal action.
Example Scenario
Consider a pedestrian on the Central Coast who was hit by a car. The insurer delays assessing the claim for over 30 days. The injured person documents the delay, contacts the insurer in writing, and escalates the issue to SIRA. SIRA reviews the claim and finds the insurer’s delay unreasonable, leading to a faster resolution. This example shows how timely action can prevent unnecessary delays.
When to Seek Advice
If the insurer refuses to pay, disputes the injury’s severity, or delays beyond 52 weeks, you should consult a legal professional. SIRA’s guidelines do not cover all scenarios, and an experienced solicitor can help you explore options like disputing the insurer’s decision or applying for a review.
Next Steps
CTP claims depend on the accident date, injury type, and insurer actions. Delayed decisions can reduce your access to benefits, so it’s crucial to act early. For personalized advice, complete the quick, no obligation enquiry form to request contact about your circumstances.