How SIRA Regulates Delayed CTP Insurer Decisions in NSW
If your CTP insurer is taking longer than expected to make a decision on your claim, SIRA provides clear rules to ensure timely resolution. Under the Motor Accident Injuries Act 2017, insurers must act promptly to avoid breaching their obligations. SIRA explains that delays beyond 60 days may trigger escalation procedures, including mandatory reviews or external mediation.
Key NSW CTP Rules on Insurer Timeframes
CTP insurers must respond to claims within 60 days of receiving all required documentation. If they fail to act within this period, SIRA mandates that insurers:
- Conduct a mandatory review of the claim
- Provide a written explanation for the delay
- Escalate the matter to a senior claims manager if the delay exceeds 90 days
These rules apply regardless of whether the claim involves soft tissue injuries, threshold injuries, or long-term care needs. SIRA emphasizes that insurers cannot unreasonably extend deadlines without justifying the delay in writing.
Practical Steps for Claimants Facing Delays
If your insurer is not responding within 60 days, take these steps:
- Request a written confirmation of the delay
- Ask for the specific reason for the delay
- Document all correspondence with the insurer
- Seek independent legal advice if the delay exceeds 90 days
SIRA recommends keeping copies of all communications, including emails, letters, and phone records. This evidence is crucial if you need to challenge the insurer's decision or request a review.
What SIRA Says About Justifying Delays
Insurers must provide a 'reasonable explanation' for delays, such as:
- Incomplete or missing documentation
- Complex medical assessments
- Requests for additional information from the claimant
If the insurer cannot justify the delay, SIRA may intervene to expedite the claim. In 2023, SIRA reported that 35% of delayed claims were resolved faster after a mandatory review was initiated.
Example: How a Delayed Decision Was Resolved
A claimant who suffered a soft tissue injury after a car accident waited 63 days for their insurer to respond. When the delay exceeded 60 days, the insurer was required to conduct a mandatory review. The review revealed the delay was due to a missing medical report, which was later provided. The insurer then processed the claim within 14 days of receiving the missing documentation.
When to Seek Legal Advice
If your insurer:
- Fails to respond within 60 days
- Refuses to provide a written explanation for delays
- Threatens to terminate the claim without justification
You should seek legal advice immediately. SIRA's rules allow claimants to request a review of the insurer's decision, but this must be done within specific time limits.
Next Steps for Claimants
CTP claims involving delayed decisions require careful attention to timeframes and documentation. SIRA's rules ensure that insurers cannot unreasonably prolong the claims process. If you're facing a delay, take action within 60 days to avoid missing critical deadlines. For personalized advice, complete the quick, no obligation enquiry form to request contact about your circumstances.