If an insurer delays a decision on your NSW Compulsory Third Party (CTP) claim, retaining the right evidence is critical. Under the Motor Accident Injuries Act 2017, claimants must demonstrate their injuries and entitlements to benefits. In Newcastle and Hunter, SIRA’s guidelines outline what records are necessary to support your case. This article explains which evidence to preserve, how SIRA’s rules apply to delayed decisions, and when to seek legal advice.
Legal Framework for CTP Claims
NSW CTP claims are governed by the Motor Accident Injuries Act 2017, which sets rules for benefits like weekly income payments and treatment costs. SIRA (State Insurance Regulatory Authority) administers these claims and provides guidance on what evidence is required. If an insurer delays a decision, it may be because they lack sufficient documentation to assess your claim. For example, if your injuries fall within the 'threshold injury' definition under the Motor Accident Guidelines, the insurer must verify this through medical records.
Key Evidence to Retain
When insurers delay decisions, claimants must keep detailed records to prove their case. Essential evidence includes:
- Medical records: All documents from doctors, physiotherapists, or specialists confirming your injuries. This includes imaging reports, treatment plans, and notes about how the injury affects your daily life.
- Accident details: Police reports, witness statements, and photographs of the scene. Even if the accident occurred in a car park or private driveway, these records help establish the incident’s circumstances.
- Communication with insurers: Save all emails, letters, and phone records with the insurer. If they request additional information, keep copies of your responses.
- Income and expenses: Proof of lost wages, medical costs, and other expenses. This supports claims for weekly income payments or treatment benefits.
- Witness statements: Written accounts from people who saw the accident or can attest to your injuries.
SIRA’s Role in Delayed Decisions
SIRA’s guidelines (https://www.sira.nsw.gov.au/claims/motor-accidents) state insurers must respond to claims within 28 days. If they delay, claimants should escalate the matter through SIRA’s dispute resolution process. For example, if an insurer refuses to pay for a 'threshold injury' without proper medical evidence, you can request a review of their decision. SIRA also provides templates for disputing delays, which are available on their website.
Time Limits and When to Seek Advice
The 52-week statutory benefit rule applies to claims where injuries are limited to 'threshold injuries' (e.g., soft tissue injuries without long-term impairment). After 52 weeks, insurers may stop paying weekly benefits unless there is ongoing impairment. If an insurer delays a decision beyond this period, you may need to seek legal advice to challenge their refusal. For instance, if your injuries worsen after 52 weeks and the insurer ignores this, you may have grounds to dispute their assessment.
Hypothetical Example
Consider a pedestrian in Newcastle who was hit by a car. Their medical records show soft tissue injuries, but the insurer delays paying for treatment. The claimant must provide evidence like a doctor’s note confirming the injury and a police report. If the insurer disputes the claim, SIRA’s guidelines require them to explain their reasoning. If they fail to respond within 28 days, the claimant can request a review through SIRA.
Next Steps
If an insurer delays a decision on your CTP claim, act quickly to preserve evidence. Time limits for benefits and disputes apply, and missing key records could weaken your case. For personalized advice, complete the quick, no obligation enquiry form to request contact about your circumstances.