If your insurer denies a Compulsory Third Party (CTP) claim after a failure to give way accident in NSW, you have legal options to challenge their decision. This article explains how to dispute a denied claim, what evidence to gather, and the steps to take in the Newcastle and Hunter regions. The NSW CTP scheme governs these claims, and understanding the process is critical to protecting your rights.
How to Challenge a Denied CTP Claim
When an insurer denies a claim, they must provide a written explanation. Common reasons include disputes over fault, injury severity, or claim eligibility. To dispute the decision, start by requesting an internal review of the insurer’s assessment. Most insurers have a formal process for this, typically within 28 days of receiving your written request. During this review, you can submit additional evidence to support your claim.
If the internal review upholds the denial, you may escalate the matter to the NSW Civil and Administrative Tribunal (NCAT) for a review. NCAT can reassess the claim based on new evidence or legal errors. This process is free but requires a formal application within 28 days of the insurer’s final decision.
Evidence to Support Your Dispute
To challenge a denied claim, gather and document the following:
- Medical records: Show the injury’s severity, treatment, and how it impacts your daily life.
- Accident reports: Obtain a police report or witness statements to establish fault.
- Photographs: Document the accident scene, vehicle damage, and any visible injuries.
- Income records: Prove financial loss if you’re claiming weekly benefits.
- Insurer correspondence: Keep copies of all communications with the insurer to track their decision-making.
The Motor Accident Injuries Act 2017 requires insurers to consider all relevant evidence, so presenting a clear, organized case is essential.
Dispute Options and Legal Pathways
If the insurer still denies your claim, you can apply to NCAT for a review. NCAT can reassess the claim based on new evidence or legal errors. This process is free but requires a formal application within 28 days of the insurer’s final decision.
In some cases, a solicitor may assist by preparing a legal submission to NCAT. However, note that a dispute does not guarantee a changed outcome. The insurer must have made a legal error or failed to consider critical evidence for your case to succeed.
Practical Example: A Typical Dispute Scenario
Consider a pedestrian injured in a failure to give way accident. The insurer denies the claim, arguing the injury is minor. The claimant submits medical evidence showing a soft-tissue injury with neurological signs, as outlined in the Motor Accident Guidelines. After an internal review, the insurer upholds the denial, but the claimant applies to NCAT for a review. NCAT finds the injury meets the threshold criteria, leading to a revised decision.
When to Seek Professional Advice
While some disputes can be handled independently, complex cases often require a solicitor. A lawyer can help draft formal submissions to NCAT, challenge legal errors, or negotiate with the insurer. Always ensure your evidence is properly documented and submitted within time limits.
Next Steps for Claimants
If your insurer denies your claim, act quickly. Request an internal review, gather evidence, and consider escalating to NCAT. Remember, the NSW CTP scheme is designed to support injured people, and you have legal rights to challenge a denial. Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.