Delayed insurer decisions, how SIRA explains the rules in regional NSW CTP claims
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 make a decision on your NSW Compulsory Third Party (CTP) claim, you are not alone. In regional NSW, delays are common, and the rules governing how insurers must act are set out by the State Insurance Regulatory Authority (SIRA). This article explains the legal framework behind delayed insurer decisions, what claimants can expect, and the steps you can take to manage the process effectively.
The NSW CTP rules that sit behind this question
Under the Motor Accident Injuries Act 2017, insurers are required to make decisions on CTP claims within a specific timeframe. While the exact time limit depends on the type of claim, the law sets out clear expectations for how insurers must act. For example, if your claim involves a threshold injury, the minimum level of injury that qualifies for benefits, the insurer must make a decision within 52 weeks of the accident. If your claim involves a more serious injury, the time limit may be longer.
SIRA provides guidance on how these rules apply in practice, especially in regional areas where access to legal resources may be limited. According to SIRA, insurers must act reasonably and in good faith when assessing claims. This means they must consider all relevant evidence, including medical reports, accident details, and witness statements, before making a decision.
Practical steps and evidence that usually matter
When dealing with a delayed insurer decision, it is important to understand what evidence is relevant and how to present it effectively. Key documents include:
- Medical records confirming your injury and its impact
- A detailed account of the accident, including the date, time, location, and any witnesses
- Correspondence with the insurer, including any requests for information or updates
- Income records, if you are claiming weekly payments
You should also keep a record of all communication with the insurer, including dates and the names of the people you spoke to. This can help you track the progress of your claim and identify any potential delays.
Time limits, disputes and when to seek advice
If your insurer has not made a decision within the expected timeframe, you may need to take action. Under the Motor Accident Injuries Act 2017, there are time limits for making claims, and failure to meet these could affect your ability to pursue compensation. However, the law also provides for review processes if you believe the insurer has made an error or is acting unreasonably.
In regional NSW, claimants may find it helpful to seek advice from a legal professional who understands the specific rules that apply to their situation. While SIRA provides guidance, the interpretation of these rules can vary, and an experienced solicitor can help ensure that your claim is handled correctly.
A hypothetical example
Consider the case of a cyclist who was injured in a collision with a car in a regional town. The cyclist submitted a claim to the insurer, but the decision was delayed for over 12 weeks. During this time, the cyclist continued to experience pain and was unable to work. The insurer eventually determined that the cyclist had suffered a threshold injury and was entitled to weekly payments. However, the delay caused the cyclist to miss out on some of the benefits they were entitled to. This example highlights the importance of understanding the rules around time limits and the need to act promptly when dealing with a delayed decision.
When to seek independent legal advice
If your insurer is taking longer than expected to make a decision, or if you believe the decision is unfair, it is important to seek legal advice. An experienced solicitor can help you understand your options, including the possibility of disputing the insurer's decision or applying for a review. They can also help you navigate the process of making a claim, especially if you are dealing with a complex or long-term injury.
Next steps
If you are dealing with a delayed insurer decision on your NSW CTP claim, it is important to understand the rules that apply to your situation. While SIRA provides guidance, the interpretation of these rules can vary, and an experienced solicitor can help ensure that your claim is handled correctly. Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.