If an insurer delays a decision on your NSW Compulsory Third Party (CTP) claim, retaining the right evidence is critical. Under NSW law, insurers must respond within set timeframes, and delays may require escalation. This article explains what records to keep, how SIRA guidelines apply, and the legal boundaries around insurer timelines.
What Evidence to Retain During Delays
When facing a delayed CTP decision, keep all documents that prove your claim and the accident's circumstances. Key records include:
- Medical records: Detailed reports from doctors, specialists, and physiotherapists confirming injuries and treatment. SIRA guidelines stress that soft tissue injuries must meet specific neurological criteria.
- Accident reports: Police reports, witness statements, and photos of the scene. These establish the incident's timeline and fault.
- Correspondence: Save all emails, letters, and phone records with the insurer. SIRA advises that insurers must acknowledge claims within 14 days and provide a decision within 28 days.
- Income records: Proof of lost wages or reduced earning capacity, especially if claiming weekly income benefits.
- Witness details: Names and contact information for anyone who saw the accident.
How SIRA Guidelines Apply to Evidence Requirements
SIRA's Motor Accident Claims page outlines that insurers must assess claims based on objective evidence. For example, soft tissue injuries (threshold injuries) require documentation of neurological signs, such as spinal nerve-root damage, as defined in the Motor Accident Guidelines. If your claim involves a threshold injury, ensure your medical team records all symptoms and test results.
SIRA also states that insurers must respond to claims within 28 days. If they fail to meet this deadline, you may need to escalate the matter through the NSW Civil and Administrative Tribunal (NCAT) or seek legal advice.
Legal Boundaries Around Insurer Decision Timelines
NSW law sets strict time limits for insurers to act. Under the Motor Accident Injuries Act 2017, insurers must:
- Acknowledge a claim within 14 days of receipt.
- Provide a decision within 28 days of the claim being accepted.
- Begin paying weekly income benefits within 28 days if the injury meets threshold criteria.
If an insurer delays beyond these limits, you may have grounds to dispute their decision. SIRA's 'What You Can Claim' page confirms that weekly income benefits are available for 52 weeks for threshold injuries, but insurers must adhere to strict timelines to qualify.
When to Seek Legal Advice
If an insurer refuses to pay, disputes the injury's severity, or delays beyond 28 days, contact a solicitor. Legal experts can help you:
- Challenge delays under the Motor Accident Injuries Act.
- Submit formal dispute requests to the insurer.
- Escalate to NCAT if necessary.
Example: A Balmain Pedestrian's Claim
Consider a scenario where a pedestrian in Balmain is hit by a car. Their medical team documents soft tissue injuries, including neurological signs. The insurer delays a decision for over 28 days. By retaining all medical records and following SIRA's timeline rules, the claimant can challenge the delay and pursue weekly income benefits.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.