Delayed Insurer Decisions in NSW CTP Claims: What You Need to Know
If your CTP insurer in Greater Sydney has not made a decision on liability after several weeks or months, you are not alone. Insurers must assess liability under the Motor Accident Injuries Act 2017 (MAIA), but delays can occur due to complexity, incomplete evidence, or administrative backlogs. The law does not set a fixed timeframe for liability decisions, but insurers are expected to act reasonably and promptly. Delays may affect your access to treatment and care benefits, weekly income payments, and future claims for damages.
How Insurers Assess Liability in NSW
Under the MAIA, insurers assess liability based on the facts of the motor accident, not on who is at fault in a moral or social sense. The insurer must determine whether the driver of the vehicle involved in the accident was negligent, and whether that negligence caused your injuries. Key factors include:
- The nature and timing of the collision, including any traffic signals, road signs, or weather conditions.
- Witness statements and police reports, if available.
- Photographs or video footage from the scene or nearby surveillance.
- Medical evidence showing the nature and timing of your injuries.
- The driver’s account and any inconsistencies in their version of events.
Insurers in Greater Sydney, like elsewhere in NSW, are required to make a decision on liability within a reasonable time. While there is no statutory deadline, delays beyond three months may be considered unreasonable, particularly if you have provided all necessary documentation and medical evidence. The insurer must notify you in writing of their decision, including the reasons for it.
Impact of Delayed Decisions on Your Claim
A delayed liability decision can affect your ability to access compensation. If liability is not determined, you may not receive:
- Treatment and care benefits, which cover medical and allied health services.
- Weekly income payments, if you are unable to work due to injury.
- The right to claim damages for pain and suffering, loss of enjoyment of life, or future care needs.
You may still be eligible for statutory benefits under the MAIA, including treatment and care, if your injuries are not considered threshold injuries. However, if you are seeking damages, a liability determination is required. Delays may also prevent you from starting a common law claim, which has a two-year limitation period from the date of the accident.
Practical Steps If Your Insurer Is Delaying
If your insurer has not made a decision on liability, take the following steps to protect your rights:
- Confirm in writing that you have provided all required documents, including medical reports, accident details, and witness contact information.
- Request a written update from the insurer, including a timeline for review.
- Keep a record of all correspondence, including dates and names of contact persons.
- Seek independent medical assessment if your treating practitioner confirms your injuries are ongoing and not resolving.
- Contact SIRA (the State Insurance Regulatory Authority) if the delay persists and you believe the insurer is not acting reasonably. SIRA provides guidance and can assist in resolving disputes.
When to Seek Legal Advice
You should consider seeking independent advice if:
- The insurer has not responded to your request for a decision within four months.
- You have been denied treatment and care benefits despite ongoing injuries.
- The insurer disputes liability without providing clear evidence.
- You are unable to return to work and are not receiving weekly income payments.
Legal advice is not required to make a claim, but it can help you understand your rights, challenge unreasonable decisions, and ensure you meet any time limits for starting a damages claim.
Hypothetical Example: A Delayed Decision in Sydney
A pedestrian in Sydney was struck by a car at a crosswalk in May 2024. The driver claimed they did not see the pedestrian due to poor lighting. The insurer took five months to assess liability. During that time, the pedestrian received treatment for a back injury but was not granted weekly income payments because liability was not determined. After seeking advice, the pedestrian submitted additional witness statements and a medical report confirming the injury was caused by the impact. The insurer later accepted liability and began paying benefits. The delay had already affected the claimant’s ability to return to work and access full compensation.
Next Steps: Protect Your Rights
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.