A threshold injury under the Motor Accident Injuries Act 2017 (NSW) includes a soft tissue injury and a psychological or psychiatric injury that is not a recognised psychiatric illness (adjustment disorder and acute stress disorder are the usual examples; s 1.6 and Motor Accident Guidelines Part 5).
If your NSW CTP insurer is delaying a decision on your motor accident claim, it's essential to understand what evidence to retain and how to proceed. Under the Motor Accident Injuries Act 2017, insurers must respond to claims within specific timeframes, but delays can occur. This guide explains the evidence you should keep, how SIRA's guidelines apply, and steps to take if your claim is delayed.
Legal Framework for Delayed CTP Decisions
NSW CTP insurers are legally required to assess claims promptly. Under the Motor Accident Injuries Act 2017, insurers must notify claimants of their decision within 28 days of receiving all required documentation. If an insurer fails to meet this deadline, it may be considered a breach of their obligations. SIRA's guidelines reinforce this, stating that delays can affect your ability to claim statutory benefits like weekly payments or treatment costs.
Evidence to Keep When Facing a Delay
When an insurer delays a decision, retaining detailed records is crucial. Key evidence includes:
- Medical records: Ensure your GP or specialist documents your injuries, treatment plans, and recovery progress. SIRA requires medical evidence to confirm your injury meets the 'threshold injury' definition.
- Accident reports: Keep police reports, witness statements, and photographs of the scene. These help establish the circumstances of the accident.
- Correspondence: Save all emails, letters, and phone records with the insurer. Note dates and times of communication to track delays.
- Income records: If you're claiming weekly payments, provide proof of lost wages or reduced income. This supports your claim for statutory benefits.
- Witness details: Store contact information for witnesses who can confirm the accident details.
Steps to Take if Your CTP Claim is Delayed
If your insurer hasn't responded within 28 days, take these actions:
- Request a written confirmation: Ask the insurer to confirm the reason for the delay in writing. This creates a record of their failure to meet deadlines.
- Escalate the issue: Contact SIRA's claims team to report the delay. They can investigate the insurer's compliance with timeframes.
- Seek independent advice: If the insurer refuses to pay or disputes your claim, consult a solicitor. Legal advice can help you pursue compensation for delays or breaches of duty.
Example Scenario
Consider a cyclist in Armidale who was hit by a car. The insurer delayed responding for 35 days, during which the cyclist's injuries worsened. By retaining medical records showing the progression of injuries and documenting the insurer's delay, the cyclist was able to claim weekly payments and treatment costs. This example highlights how evidence and timely action can protect your rights.
When to Seek Legal Advice
If your insurer refuses to pay, disputes your claim, or continues to delay decisions, it's time to seek legal advice. A solicitor can help you understand your options, including disputing the insurer's decision or pursuing compensation for breach of duty. Remember, every claim depends on its own facts, and legal advice can help you navigate the process effectively.
Next Steps
CTP claims can be complex, especially when insurers delay decisions. By keeping detailed records and understanding your rights under NSW law, you can protect your entitlements. If you're in Armidale and need guidance on your specific situation, complete the quick, no obligation enquiry form to request contact about your circumstances.