What Happens If an Insurer Delays a CTP Decision?
If an insurer in New South Wales delays making a decision on a Compulsory Third Party (CTP) claim, the claimant may experience uncertainty about financial support, medical treatment coverage, and the path to compensation. Under the Motor Accident Injuries Act 2017 (MAIA), insurers are required to assess claims within a reasonable timeframe. Delays may occur due to incomplete documentation, complex injury assessments, or internal processing backlogs. While the law does not specify a fixed number of days for a decision, insurers must act promptly and fairly. In regional NSW, where access to legal and medical services may be more limited, delays can have a greater impact on daily life and recovery.
How SIRA Regulates Insurer Timeliness
The State Insurance Regulatory Authority (SIRA) oversees CTP claims in NSW and ensures insurers comply with the Motor Accident Injuries Act 2017. SIRA does not set a strict deadline for insurer decisions, but it expects insurers to act within a reasonable time. If a claimant believes the delay is unreasonable, they may request a review of the insurer’s actions. SIRA provides guidance on the expected conduct of insurers, including timely communication, proper assessment of injury and financial loss, and prompt handling of treatment and care claims. Insurers must also notify claimants of any decisions, including reasons for delays, in writing.
Practical Steps to Address a Delayed Decision
If your CTP claim is delayed, take these steps to help move the process forward:
- Contact the insurer in writing to request a progress update and confirm the status of your claim.
- Provide any missing documentation, such as medical reports, accident scene photos, or witness statements, to support your claim.
- Keep a record of all correspondence, including dates, times, and names of contact persons.
- Request a formal written response if the insurer does not provide an update within 14 days of your request.
- If the insurer fails to respond or refuses to assess your claim, you may contact SIRA for assistance.
SIRA offers a free, confidential advice service for claimants who believe their insurer is not acting fairly or in a timely manner. You can access this through the SIRA website or by calling their claims support line.
What Options Are Available If Your Claim Is Delayed?
If an insurer continues to delay or refuses to make a decision, you have several options under NSW law:
- You may request a review of the insurer’s decision through SIRA’s formal dispute resolution process. This is available if the insurer has declined your claim or failed to respond.
- You can apply to the Civil and Administrative Tribunal (NCAT) for a determination on the insurer’s conduct, particularly if the delay is affecting your access to treatment, income, or financial support.
- In some cases, you may be eligible for interim payments to cover urgent medical or living expenses while the claim is under review.
A claimant in regional NSW who was injured in a car accident in June 2024 and has not received a decision on their claim after 10 months may consider escalating to SIRA. They have a right to expect a timely response, and SIRA can intervene if the insurer’s actions fall below the standard expected under MAIA.
Time Limits and Procedural Requirements
There are time limits that may affect your ability to pursue a claim, even if the insurer is delayed. Under the Motor Accident Injuries Act 2017, you must generally notify the insurer of your claim within 6 months of the accident. Failure to do so may prevent you from claiming compensation, even if the insurer is at fault for the delay. Additionally, if you are seeking damages for injury, you must file a claim within 3 years of the accident.
If you have not yet notified the insurer, or if you believe your claim has been overlooked, it is important to act quickly. The longer you wait, the more difficult it may become to prove the injury was caused by the accident, particularly if medical records are not contemporaneous.
When to Seek Independent Advice
A delayed insurer decision does not automatically mean the claim will be denied. However, if you are unsure about your rights, the insurer’s response is unclear, or you are experiencing financial hardship due to the delay, it is advisable to seek independent legal advice. A solicitor experienced in CTP claims can help you understand your options, review the insurer’s correspondence, and assist in escalating the matter to SIRA or NCAT if necessary.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.