What Constitutes a Delayed Insurer Decision in NSW CTP Claims?
A delayed insurer decision in a NSW Compulsory Third Party (CTP) claim occurs when an insurer does not make a determination on a claim within a reasonable timeframe, despite having received all necessary information. Under the Motor Accident Injuries Act 2017 (MAIA), insurers are required to process claims promptly and in good faith. While the Act does not prescribe a fixed timeframe for every decision, delays that are unexplained or unreasonable may be considered a failure to meet statutory obligations. This is particularly relevant in Greater Sydney, where claim volumes are high and insurer processing times can vary significantly.
How Insurers Justify Delays in CTP Claim Processing
Insurers may cite several reasons for delays, including the need to review medical evidence, assess liability, or gather additional documentation. Under SIRA’s guidance, insurers must notify claimants of the progress of their claim and provide a reason for any delay. Common justifications include pending medical reports, disputes over fault, or the need to obtain a formal assessment of impairment. However, an insurer cannot delay a decision indefinitely. If a claimant has provided all required information and the insurer still fails to act, the delay may be considered unreasonable and potentially actionable.
Practical Steps if Your Insurer Is Delaying a Decision
If you believe your insurer is delaying a decision, take the following steps:
- Confirm that all required documents have been submitted, including medical reports, accident details, and proof of income loss.
- Request a written update from the insurer outlining the reason for the delay and the expected timeframe for a decision.
- Keep a record of all correspondence, including dates and details of phone calls or emails.
- If the delay persists, contact SIRA directly through their claims assistance service. SIRA provides guidance on insurer conduct and can assist in resolving disputes.
SIRA’s policy is that insurers must act within a reasonable time, and claimants have the right to expect timely responses. Failure to do so may result in a formal complaint to SIRA, which can investigate the insurer’s conduct.
What SIRA Guidance Says About Processing Delays
SIRA’s published guidance on motor accident claims states that insurers must not unreasonably delay decisions. While there is no fixed 30-day rule, SIRA expects insurers to resolve claims within a timeframe that reflects the complexity of the matter and the availability of evidence. For straightforward claims with clear liability and minor injuries, a decision should generally be made within 60 to 90 days of receiving all information.
If an insurer fails to make a decision within a reasonable period, SIRA may intervene. Claimants can request a review of the insurer’s actions, and SIRA may issue a formal direction if it finds the delay to be unjustified. This process is available to all claimants, including those in Greater Sydney, and does not require legal representation.
When to Seek Independent Advice
A delay in decision-making does not automatically mean the claim will be denied. However, prolonged inaction may affect your ability to access benefits such as weekly income payments or treatment and care benefits. If your insurer has not responded to a formal request for an update, or if you believe the delay is unreasonable given the evidence you have provided, it may be appropriate to seek independent legal advice.
Independent advice can help you understand your rights under the MAIA, assess whether the insurer’s conduct is compliant with SIRA standards, and determine whether a formal complaint to SIRA or a review of the insurer’s decision is warranted. This is particularly important if you are experiencing financial hardship due to delayed payments.
Hypothetical Example: A Claimant in Greater Sydney
A pedestrian in Sydney’s inner west was struck by a car in a crosswalk in April 2024. The driver admitted fault, and the claimant submitted a claim to the insurer within two weeks. The insurer requested medical reports, which were provided by the treating doctor in June 2024. Despite this, the insurer did not issue a decision on benefits until November 2024, five months after the medical evidence was received. The claimant contacted SIRA, which confirmed that the delay was unreasonably long given the clarity of liability and the prompt submission of evidence. SIRA advised the insurer to finalise the claim within 14 days, and the insurer subsequently approved weekly payments and treatment benefits.
Next Steps and How to Request Contact
Every claim depends on its own facts. Insurer decisions in CTP claims are governed by the Motor Accident Injuries Act 2017 and SIRA’s administrative guidance. Delays may occur, but they are not inevitable. If you are experiencing a delay in your CTP claim, it is important to act promptly to protect your rights.
To request contact about your circumstances, complete the quick, no obligation enquiry form.