Delayed Insurer Decisions in NSW CTP Claims: What You Need to Know
If you’ve been involved in a motor accident in Greater Sydney and your CTP insurer has not made a decision on your claim within a reasonable timeframe, you are not alone. Delays in insurer decisions are a common concern, particularly in busy urban areas like Sydney’s Inner West, North Shore, and Eastern Suburbs. While the law does not set a fixed deadline for every insurer decision, the Motor Accident Injuries Act 2017 and SIRA’s guidelines establish clear expectations for timely processing. Understanding these expectations and knowing what to do next can help you manage the process and protect your rights.
The Legal Framework for Insurer Decision Timelines
Under the Motor Accident Injuries Act 2017 (MAIA), insurers must assess and respond to claims in a timely and fair manner. SIRA, the NSW regulator, states that insurers are expected to process claims as quickly as possible, particularly where injuries are serious or treatment is ongoing. While there is no statutory timeframe for every decision, SIRA has issued guidance that insurers should not unreasonably delay decisions on claims, especially when medical evidence is available.
For example, if you have sustained a soft tissue injury and are receiving treatment, the insurer must acknowledge your claim and begin processing it within a reasonable period. Delays beyond what is considered reasonable, typically more than 60 days from submission of complete documentation, may indicate a failure to meet statutory obligations under the MAIA.
Practical Steps When Your Insurer Is Delayed
If your insurer has not responded to your claim within 60 days, or if you have not received a decision on a benefit you’ve applied for, you should take the following steps:
- Contact your insurer in writing to request a status update and ask for a written explanation if the delay continues.
- Gather and preserve all evidence related to your claim: medical reports, treatment records, accident scene photos, witness contact details, and correspondence with the insurer.
- If you have not already done so, submit a formal claim to your insurer using the SIRA claim form or their online portal.
- Keep a record of all communications, including dates and details of phone calls and emails.
These actions help establish a clear paper trail and demonstrate that you have made reasonable efforts to progress your claim.
Real-Life Example: A Claimant in North Sydney
Consider a scenario involving a 38-year-old cyclist in North Sydney who was struck by a car at a roundabout in August 2026. The cyclist sustained a whiplash injury and required physiotherapy. They reported the accident to their insurer within a week and submitted medical evidence within 10 days.
Despite this, the insurer did not acknowledge the claim for 90 days. The claimant followed up via email and received no response for another 30 days. At this point, the claimant contacted SIRA’s claims assistance team. SIRA reviewed the case and confirmed that the insurer had failed to act within a reasonable timeframe. The insurer was required to reassess the claim and pay a treatment and care benefit for the first 52 weeks, as the injury was classified as a threshold injury under the Motor Accident Guidelines.
This example illustrates that delays are not acceptable, and claimants have recourse through SIRA.
What SIRA Says About Insurer Processing Times
SIRA’s guidance on making a motor accident claim states that insurers must not unreasonably delay decisions. While SIRA does not prescribe a fixed number of days for every decision, it expects insurers to act promptly, particularly when:
- Medical evidence is available and supports a claim for benefits.
- The claimant has provided all required documentation.
- The injury is not minor and may result in ongoing treatment or financial loss.
SIRA notes that delays may be considered unreasonable if they prevent a claimant from accessing timely treatment, income support, or other benefits. In such cases, claimants may request SIRA to review the insurer’s conduct.
Dispute and Escalation Options
If your insurer continues to delay or refuses to make a decision, you may escalate the matter through the following steps:
- Submit a formal complaint to the insurer’s internal dispute resolution process. Most CTP insurers are required to have a process for handling disputes.
- If the insurer does not resolve the issue within 30 days, you can contact SIRA directly to request an investigation into the insurer’s conduct.
- SIRA may issue a direction to the insurer to act, or in some cases, refer the matter to the NSW Civil and Administrative Tribunal (NCAT) if a formal dispute arises.
You may still be entitled to weekly income payments, treatment and care benefits, or damages, depending on your injury and circumstances.
Time Limits and Procedural Requirements
While delays in insurer decisions are a concern, it is equally important to be aware of time limits that apply to your claim. Under the MAIA, you must generally make a claim within three years of the accident date. However, this period may be shorter if you are seeking damages for a serious injury.
If you have not received a decision on your claim within 120 days of submitting complete documentation, you should seek independent advice. The longer a delay continues, the more difficult it becomes to establish that the insurer failed to act in a timely manner.
Next Steps: What You Should Do Now
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.