Understanding Delayed Insurer Decisions in NSW CTP Claims
If an insurer in Balmain, NSW, has not made a decision on your CTP claim within a reasonable time, you may be entitled to escalate the matter through formal processes. Under the Motor Accident Injuries Act 2017, insurers must assess and respond to claims within a timeframe that is considered reasonable in the circumstances. While the law does not prescribe a fixed number of days, delays beyond what is reasonable may give rise to a right to apply to the State Insurance Regulatory Authority (SIRA) for a determination. SIRA provides guidance on how to proceed when an insurer is not acting promptly, and claimants can seek a formal review of the insurer’s conduct.
Legal Timeframes and SIRA’s Role in NSW CTP Claims
There is no statutory deadline in the Motor Accident Injuries Act 2017 for insurers to make a decision on a CTP claim. However, SIRA expects insurers to act within a reasonable time, which may vary depending on the complexity of the claim, the nature of the injuries, and whether medical treatment and evidence have been fully provided. SIRA’s guidance states that a delay of more than three months from the date of claim submission may be considered unreasonable, particularly if the claimant has already provided all necessary documentation.
SIRA does not determine whether a claim is valid or how much compensation should be paid. Instead, it can review whether an insurer has failed to act reasonably in processing a claim. If you believe your insurer has not responded within a reasonable timeframe, you may request a determination from SIRA under the Motor Accident Injuries Act 2017. This process allows SIRA to assess whether the insurer’s delay breaches its obligations under the CTP scheme.
Practical Steps When an Insurer Delays a Decision
If your insurer has not responded to your CTP claim within a reasonable period, take the following steps:
- Confirm that you have submitted all required documentation, including a completed claim form, medical reports, treatment records, and proof of income loss.
- Send a written letter to the insurer requesting a formal response within 14 days, referencing your claim number and the date of submission.
- Keep a record of all correspondence, including email timestamps, letters sent, and any responses received.
- If no response is received within 14 days, you may apply to SIRA for a determination that the insurer has failed to act reasonably.
SIRA’s online portal allows claimants to submit a request for a determination. You must provide evidence that you have made a reasonable effort to resolve the matter directly with the insurer. SIRA will not intervene unless it is satisfied that the insurer has not acted in good faith or has failed to respond to a properly submitted claim.
How Delayed Decisions Affect Your CTP Benefits and Rights
A delayed insurer decision does not automatically stop your entitlement to CTP benefits. If you have provided all necessary evidence and the insurer fails to act, you may still be eligible for treatment and care benefits, weekly income payments, and, if applicable, damages. However, delays in decision-making may affect the timing of payments, particularly for weekly income benefits, which are only payable from the date the insurer accepts liability or a determination is made.
SIRA’s policy is that a claimant should not be penalised for an insurer’s delay. If SIRA finds that an insurer has not acted reasonably, it may order the insurer to pay benefits from the date the claim was first made, or from the date the insurer should have responded, depending on the circumstances.
When to Seek Independent Advice
If your insurer has not responded to your claim within three months, or if you have been denied benefits without a clear explanation, it may be appropriate to seek independent legal advice. A solicitor experienced in motor accident compensation can help you assess whether the insurer’s delay constitutes a breach of duty under the CTP scheme and assist in preparing a formal application to SIRA.
A hypothetical example: A pedestrian in Balmain was struck by a car in February 2026. They submitted a CTP claim in March 2026, including medical reports and a doctor’s certificate of injury. The insurer did not respond until August 2026. The claimant applied to SIRA, which found the delay unreasonable. SIRA ordered the insurer to pay weekly income benefits from the date of claim submission, and to cover all treatment and care costs incurred during the delay.
Next Steps and How to Request Contact
Every claim depends on its own facts. The timing, nature of injuries, and completeness of evidence all affect whether a delay in decision-making can be challenged. SIRA’s role is to ensure insurers act fairly and within a reasonable timeframe, but it does not replace the need for timely and accurate claim submission.
To request contact about your circumstances, complete the quick, no obligation enquiry form.