Delayed Insurer Decisions, What Claimants Need to Know
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 your insurer is taking longer than expected to decide on your NSW Compulsory Third Party (CTP) claim, you’re not alone. Insurers are legally required to act within specific timeframes under the Motor Accident Injuries Act 2017. Delays can disrupt your access to benefits like weekly payments or treatment costs, especially on the Central Coast where claims are processed through the State Insurance Regulatory Authority (SIRA). This article explains your rights, practical steps to take, and when to seek legal advice.
Legal Obligations of Insurers Under NSW CTP Laws
Under NSW CTP rules, insurers must respond to claims within 28 days of receiving a completed claim form, unless they request additional information. If they delay beyond this period, they may breach their duty to act promptly. SIRA’s guidelines state that insurers should provide a written decision within 28 days, including reasons for any delays. If an insurer fails to meet this deadline, claimants may have grounds to escalate the matter.
Practical Steps for Claimants on the Central Coast
If your insurer is slow to act, take these steps:
- Keep records of all communication, save emails, letters, and phone call notes.
- Request a written timeline, ask the insurer to confirm when they expect to make a decision.
- Submit medical evidence promptly, provide updated treatment records and medical reports to support your claim.
- Monitor insurer activity, check if the insurer has submitted your claim to SIRA for assessment.
Insurers may delay decisions to avoid paying benefits, but SIRA’s rules set clear boundaries. If your insurer fails to act within 28 days, you can escalate the issue to SIRA or seek legal advice.
Time Limits and Dispute Options
NSW CTP claims must be submitted within 52 weeks of the accident, but this timeframe does not apply to disputes over delayed decisions. If your insurer refuses to pay benefits after 28 days, you can:
- Escalate to SIRA, contact SIRA’s claims team to report the delay.
- File a complaint, use the NSW Ombudsman’s complaint process if the insurer ignores your request.
- Seek legal advice, a solicitor can help you challenge the insurer’s decision or apply for an independent review.
Example: What Happens if an Insurer Delays a Decision?
Consider a claimant who suffered a soft-tissue injury (a threshold injury) after a car accident on the Central Coast. The insurer delays its decision for 30 days, during which the claimant incurs additional medical costs. Under SIRA’s rules, the insurer must provide a written decision within 28 days. If it fails to do so, the claimant can request a review of the insurer’s decision and seek compensation for the delay.
When to Seek Legal Advice
If your insurer refuses to pay benefits, ignores your requests, or claims your injury does not meet the threshold, you should consult a solicitor. Legal advice is essential if:
- The insurer denies your claim without a valid reason.
- You believe the insurer is breaching its legal obligations.
- You need help disputing a decision or applying for an independent review.
Next Steps
Understanding insurer obligations and your rights under NSW CTP laws is crucial when dealing with delayed decisions. If your insurer is not acting within the required timeframe, take action to protect your claim. Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.