Delayed insurer decisions, what injured people need to know in NSW
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 an insurer delays making a decision on your Compulsory Third Party (CTP) claim, it can create uncertainty about your right to compensation. Under NSW law, insurers must act promptly to assess claims, but delays can occur. This article explains how delays affect your claim, what steps to take, and when to seek legal advice.
NSW CTP rules behind delayed decisions
The Motor Accident Injuries Act 2017 (MAIA) and SIRA guidelines set the framework for CTP claims. Insurers must evaluate claims within a reasonable time, though there is no fixed deadline. Delays can disrupt access to benefits like weekly payments or treatment costs, especially if your injuries meet the 'threshold injury' definition under the MAIA.
Key rules include:
- Time limits for benefits: If your only injuries are threshold injuries, weekly benefits and treatment payments generally stop after 52 weeks. Delays in insurer decisions could push this deadline past, affecting your entitlement.
- Insurer obligations: Insurers must provide a written decision within 28 days of receiving a claim form (per SIRA guidelines). If they fail to act within this timeframe, you may have grounds to escalate the matter.
- No fault requirement: CTP claims are based on the at-fault driver’s insurance, not the injured person’s own fault. Delays should not affect this principle.
Practical steps when insurers delay
If your insurer is slow to respond, take these steps:
- Keep records: Document all communications, including dates and details of conversations with the insurer.
- Request written confirmation: Ask for a written timeline for the insurer’s decision. This helps prove delays.
- Escalate the claim: Use the insurer’s internal escalation process. SIRA guidelines state claims must be reviewed by a claims manager within 28 days of submission.
- Seek independent advice: If the insurer refuses to act, consult a legal professional. Delays can sometimes indicate a pattern of non-compliance.
How to challenge a delayed decision
Under the MAIA, insurers must provide a written decision within 28 days of receiving a claim form. If they fail to act within this timeframe, you may:
- File a complaint with SIRA, the NSW government agency overseeing CTP claims.
- Apply to the NSW Civil and Administrative Tribunal (NCAT), if the insurer refuses to pay benefits.
- Pursue legal action, if the delay causes financial hardship or prevents access to essential treatment.
Time limits and when to act
While there is no set timeframe for insurers to make a decision, delays can affect your ability to claim benefits. For example:
- If your claim is delayed beyond 52 weeks, you may lose access to weekly payments for threshold injuries.
- If the insurer fails to respond within 28 days, you may have grounds to challenge their decision.
Example: How a delay affects a claim
Consider a scenario where a pedestrian is injured in a car accident. The insurer delays assessing the claim for 30 days. During this time, the injured person cannot access weekly payments for their threshold injuries. This delay could push their benefits past the 52-week limit, reducing their overall compensation.
When to seek legal advice
Contact a legal professional if:
- The insurer refuses to pay benefits.
- You are unsure whether your injuries meet the threshold for benefits.
- You need help challenging a delayed decision.
Next steps
CTP claims depend on the timing of injuries, insurer actions, and legal deadlines. If you are in Balmain or elsewhere in NSW and facing delays, it is important to act quickly. Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.