If an insurer delays a decision on your NSW Compulsory Third Party (CTP) claim, you need to act quickly to protect your rights. Under the Motor Accident Injuries Act 2017, insurers must respond to claims within specific timeframes. Delays can affect your access to benefits like weekly payments or treatment costs. This article explains your options, including how to challenge delays and what evidence to gather.
Legal Timeframes for CTP Claims
NSW insurers must respond to a CTP claim within 28 days of receiving a completed claim form, according to SIRA guidelines. If the insurer delays beyond this period, it may be considered a breach of its obligations. However, the 28-day rule applies only to initial decisions, not to reviews or disputes.
If your claim involves a threshold injury (a soft tissue injury meeting specific medical criteria), the insurer must assess your claim within 28 days of the accident. For more serious injuries, the insurer has 28 days to decide on benefits like weekly payments or treatment costs. If the insurer fails to meet these deadlines, you may have grounds to challenge the delay.
Practical Steps for Injured Claimants
When an insurer delays a decision, take the following steps:
- Document the delay: Keep a record of all communications with the insurer, including dates and times of phone calls, emails, or letters.
- Request written confirmation: Ask the insurer to confirm the reason for the delay in writing. This helps establish a timeline for your claim.
- Escalate to SIRA: If the insurer does not respond within 28 days, contact the State Insurance Regulatory Authority (SIRA) to report the delay. SIRA oversees insurers and can investigate complaints.
- Seek legal advice: If the insurer refuses to pay or disputes your claim, consult a solicitor specialising in CTP claims. They can help you challenge the insurer’s decision or pursue a dispute through the NSW Civil and Administrative Tribunal (NCAT).
How to Challenge a Delayed Decision
To challenge a delayed decision, you must show that the insurer’s delay caused you harm, such as financial loss or worsening of your injury. For example, if the insurer delayed paying for essential treatment, you may be able to claim additional compensation for the period of delay.
If the insurer claims your claim is 'not valid' or 'not covered' after the 28-day period, you should request a written explanation. If the insurer does not provide a valid reason, you may need to dispute the decision through NCAT. Under the Motor Accident Injuries Act 2017, insurers must provide a written explanation for any refusal to pay.
When to Seek Legal Advice
You should seek legal advice if:
- The insurer refuses to pay or disputes your claim.
- You believe the insurer has acted unreasonably or in bad faith.
- You need help preparing a dispute or applying for a review.
A solicitor can help you understand your rights under the CTP scheme and ensure you meet all legal deadlines. They can also help you challenge delays that affect your access to benefits like weekly payments or treatment costs.
Example: What Happens If an Insurer Delays a Decision?
Imagine you were in a car accident and suffered a soft tissue injury. You submitted your claim to the insurer, but they delayed their decision for over 28 days. During this time, you were unable to afford necessary treatment. You could argue that the insurer’s delay caused you additional harm and may be able to claim compensation for the period of delay.
In this case, you should document the delay, request a written explanation from the insurer, and consider seeking legal advice to challenge the delay.
Next Steps
If you are facing a delayed CTP decision, take action to protect your rights. Document the delay, escalate the issue to SIRA, and seek legal advice if needed. Every claim depends on its own facts, and the steps you take can significantly affect your outcome.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.