If you're an injured road user in Greater Sydney facing delays from your insurer over a CTP claim, timeframes and procedural steps are critical. Under NSW law, insurers must respond to claims within specific timeframes, and delays can impact your ability to claim benefits or damages. This article explains your legal rights, practical steps to take during delays, and how SIRA oversees insurer compliance.
Legal Framework for CTP Claims
- New South Wales' Compulsory Third Party (CTP) scheme, governed by the Motor Accident Injuries Act 2017, requires insurers to assess claims promptly. While the Act doesn't specify a fixed timeframe for insurer decisions, delays beyond 28 days may trigger legal action under the
- NSW Civil Procedure Act 2009* (s 129). Insurers must also respond to requests for information within 14 days under the
- Motor Accident Injuries Regulation 2017* (s 3.11). Delays beyond these thresholds may indicate procedural failure.
Practical Steps During Delays
When an insurer is slow to act, take these steps:
- Document all correspondence - Keep copies of emails, letters, and phone records showing the insurer’s delay.
- Request written confirmation - Ask the insurer to confirm the date they received your claim and the expected timeline for a decision.
- Submit medical evidence promptly - Provide your treating doctor’s records to support your claim, as delays in treatment may affect benefits.
- Check for statutory benefits
- If your injury meets the
- threshold injury* definition (e.g., soft tissue injury with neurological signs), you may be eligible for weekly payments under the CTP scheme.
Impact of Delays on Claims
Delays can affect your claim in several ways:
- Loss of weekly benefits - If your injury is a threshold injury, benefits are limited to 52 weeks under s 4.4 of the MAIA. Delays may mean you miss out on payments.
- Disruption of treatment - Prolonged delays in insurer decisions can delay access to specialist care, affecting recovery and long-term outcomes.
- Legal action timelines
- Under the
- NSW Civil Procedure Act 2009*, you have 6 years from the accident date to pursue a claim. However, delays may complicate your ability to meet procedural deadlines.
SIRA’s Role in Resolving Delays
The State Insurance Regulatory Authority (SIRA) oversees CTP insurers and ensures compliance with the Motor Accident Injuries Act 2017. If your insurer fails to act within reasonable timeframes, you can:
- Submit a complaint to SIRA
- SIRA’s
- Motor Accident Claims* page outlines how to report insurer failures (https://www.sira.nsw.gov.au/claims/motor-accidents).
- Request a review of your claim - SIRA may intervene if your insurer’s decision is disputed or if there are concerns about the claim’s validity.
- Seek legal advice - If your insurer refuses to pay or delays beyond 28 days, consult a solicitor to explore options like mediation or court action.
Example: A Pedestrian’s Delayed Claim
Consider a scenario where a pedestrian is injured in a car accident in Sydney. The insurer takes 45 days to respond, during which the injured person delays seeking specialist treatment. This delay could:
- Reduce weekly benefits if the injury is classified as a threshold injury.
- Create disputes over whether the injury meets the
- spinal nerve-root qualification* (s 3.28 of the MAIA).
- Require SIRA intervention to resolve insurer compliance issues.
Next Steps
If your insurer is unresponsive or your claim is delayed, act quickly. Document all interactions, submit required evidence, and consider contacting SIRA or a legal professional. Every claim depends on its own facts, and time limits may apply.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.