Delayed insurer decisions and treatment funding in NSW CTP claims
If an insurer delays making a decision on your CTP claim in New South Wales, it may affect when and how treatment costs are funded. This can be particularly challenging in regional areas where access to medical services and legal advice may be limited. Under the Motor Accident Injuries Act 2017, insurers are required to assess claims and determine eligibility for benefits within a reasonable timeframe. However, delays can occur due to incomplete information, complex injury patterns, or administrative backlogs.
Legal framework for treatment funding in NSW CTP claims
Treatment and care benefits under the CTP scheme are designed to cover reasonable and necessary medical treatment arising from a motor accident. These benefits are not dependent on fault and are available regardless of whether the insurer has yet made a formal decision on your claim. The insurer must provide treatment and care benefits if the injury is caused by a motor accident and the treatment is reasonable and necessary.
If you have been injured in a motor accident in NSW, you are entitled to treatment and care benefits under the Motor Accident Injuries Act 2017, even while the insurer is still assessing your claim. This means that medical practitioners can begin treatment and submit claims for funding, provided the treatment is related to the accident and meets the criteria for reasonableness and necessity.
Practical steps when insurer decisions are delayed
If your insurer is taking longer than expected to decide on your claim, you should take the following steps to protect your access to treatment funding:
- Contact the insurer in writing to request a status update and confirm the expected timeframe for a decision.
- Provide any missing documentation, such as medical reports, accident details, or witness statements, to help the insurer process your claim.
- Keep a record of all correspondence, including dates, times, and details of conversations.
- Ensure that your medical practitioner submits itemised treatment invoices to the insurer for approval and funding.
- If treatment is urgent and funding is not approved, you may need to pay for treatment upfront and seek reimbursement later. In such cases, retain all receipts and invoices.
In regional NSW, where medical services may be further from major centres, delays in insurer decisions can impact timely access to care. It is important to act promptly to avoid treatment gaps.
How SIRA supports claimants with delayed insurer decisions
The State Insurance Regulatory Authority (SIRA) oversees the CTP scheme in NSW and provides guidance and support for claimants experiencing delays. SIRA does not make decisions on individual claims, but it can assist if you believe your insurer is not acting within a reasonable timeframe.
If you have made reasonable efforts to resolve the delay and the insurer has not responded or made a decision, you may contact SIRA’s claims team for assistance. SIRA can help clarify the insurer’s obligations and may intervene to encourage timely processing. However, SIRA cannot override an insurer’s decision or force payment of benefits.
SIRA also provides a claims information line and online resources to help claimants understand their rights and options. These resources are particularly useful for people in regional areas who may not have easy access to legal or claims support services.
Time limits and dispute options
There are time limits for making claims under the CTP scheme. You must generally notify your insurer of your claim within 6 months of the accident. However, the 6-month timeframe does not apply to treatment and care benefits, which are available as long as the treatment is related to the accident and is reasonable and necessary.
If your insurer refuses to fund treatment or delays approval without reasonable cause, you may have the right to dispute the decision. You can request a review from the insurer or apply to the Civil and Administrative Tribunal (NCAT) for a determination. NCAT can order the insurer to fund treatment and may award interest on delayed payments.
In regional NSW, where claimants may face additional barriers to accessing legal advice, it is important to act early. Delays in seeking a review or filing a dispute may affect your ability to recover costs or claim damages later.
Hypothetical example: Treatment funding delay in regional NSW
A cyclist in Wagga Wagga was struck by a car in a rural area in June 2026. The cyclist sustained a back injury and required physiotherapy and specialist consultations. The insurer did not respond to the initial claim for over 10 weeks. During this time, the cyclist received treatment from a local clinic and paid for the services out of pocket.
The cyclist contacted the insurer in writing, submitted medical reports, and requested a decision. After another 4 weeks with no response, the cyclist contacted SIRA for assistance. SIRA advised that the insurer had a duty to act within a reasonable timeframe and encouraged the insurer to respond. The insurer eventually approved funding for the treatment, but only after the cyclist had paid for services and submitted a claim for reimbursement.
This example illustrates how delays can affect access to care and financial burden, particularly in regional areas.
Next steps and when to seek advice
Delayed insurer decisions can disrupt access to essential treatment and create financial pressure. While the CTP scheme provides for treatment and care benefits regardless of a formal decision, delays in approval can result in out-of-pocket expenses.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.