Delayed insurer decisions, practical NSW examples (NSW-wide)
If an insurer delays responding to your NSW Compulsory Third Party (CTP) claim, it can affect your ability to claim compensation. This article explains the legal rules, practical steps, and how to manage delays while pursuing your claim.
Legal timeframes for NSW CTP insurer decisions
Under the Motor Accident Injuries Act 2017, insurers must respond to claims within a reasonable timeframe. While the exact period isn't specified in legislation, the NSW government’s SIRA (State Insurance Regulatory Authority) enforces timely decisions. For example, if an insurer fails to respond within 28 days of receiving a claim form, claimants may need to escalate the matter.
SIRA’s guidelines state that insurers should act promptly to avoid unnecessary delays. If an insurer’s response is unreasonable, claimants can request a review or escalate the issue to SIRA.
How delays impact your claim
Delays can disrupt your ability to pursue compensation, especially if your claim depends on evidence like medical records or accident reports. For instance, if an insurer delays assessing your injuries, you may miss opportunities to secure treatment benefits or weekly income payments.
If your claim involves a threshold injury (such as soft tissue damage), delays could affect your eligibility for benefits after 52 weeks. The Motor Accident Injuries Act 2017 specifies that weekly benefits and treatment payments are limited to 52 weeks if your injuries are only threshold injuries. Delays may push your claim beyond this period, reducing your entitlements.
Steps to take if an insurer delays
- Keep records: Document all communication with the insurer, including dates, times, and details of interactions. Save copies of emails, letters, and phone records.
- Request a written timeline: Ask the insurer to provide a written estimate of when they expect to make a decision. This helps track progress and identify unreasonable delays.
- Escalate to SIRA: If the insurer fails to respond within a reasonable time, contact SIRA. You can submit a complaint through SIRA’s online portal or by phone. SIRA will investigate and may require the insurer to comply with its guidelines.
- Seek legal advice: If delays are causing financial hardship or jeopardizing your claim, consult a solicitor. They can help you understand your options, including applying for an urgent review or disputing the insurer’s decision.
SIRA’s role in enforcing timely decisions
SIRA oversees CTP insurers to ensure they meet their obligations under the Motor Accident Injuries Act 2017. If an insurer consistently delays decisions, SIRA may impose penalties or require the insurer to improve its processes. Claimants can request a copy of SIRA’s enforcement reports to understand how insurers are performing.
Practical example: Delays and threshold injuries
Consider a claimant who suffered a soft tissue injury (a threshold injury) in a car accident. The insurer delayed assessing the injury for 30 days, during which time the claimant’s treatment benefits were paused. By the time the insurer made its decision, the claimant had already exceeded the 52-week limit for weekly payments. This delay reduced the claimant’s overall compensation entitlements.
What to do next
If you’re facing delays with your CTP claim, take action to protect your rights. Document all evidence, request a timeline from the insurer, and escalate the issue to SIRA if needed. Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.