Dispute Resolution Options for Distracted Driving CTP Claims in Newcastle and Hunter
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 CTP claim for injuries caused by distracted driving has been denied or partially refused in the Newcastle and Hunter region, you have formal options to challenge the decision. The dispute resolution process is governed by the Motor Accident Injuries Act 2017 and administered by the State Insurance Regulatory Authority (SIRA). You may seek an internal review from the insurer, apply to the Personal Injury Commission (PIC) for a review, or pursue mediation. These options are available regardless of whether the accident occurred on a public road, in a car park, or on private property, provided the motor vehicle was used in a way that falls under the CTP scheme.
How SIRA Handles CTP Disputes Involving Distracted Driving
SIRA oversees all motor accident claims in NSW, including those where distracted driving is a factor. The insurer must assess whether the injury arose from a motor vehicle accident and whether the claimant is entitled to benefits under the CTP scheme. If the insurer denies a claim based on factors such as fault, injury threshold, or treatment duration, the claimant may request a review. Distracted driving, including mobile phone use, eating, or adjusting vehicle controls, may be established through witness statements, mobile phone data, or traffic camera footage. However, the insurer’s assessment must still comply with the Motor Accident Injuries Regulation 2017 and the Motor Accident Guidelines.
Practical Steps to Resolve a Denied CTP Claim
To resolve a dispute, begin by obtaining a written explanation from the insurer outlining the reasons for the denial. Gather and preserve all relevant evidence, including:
- Medical records detailing injury diagnosis and treatment
- Police reports or accident scene photos
- Witness contact details and statements
- Mobile phone records showing usage at the time of the accident
- Correspondence with the insurer
If the insurer refuses to reconsider, you may apply to the Personal Injury Commission (PIC) for a review. The PIC has jurisdiction to assess whether the insurer’s decision was correct under the Motor Accident Injuries Act 2017. You must submit your application within 12 months of the insurer’s final decision, unless a time extension is granted.
Internal Review and Mediation Pathways
Before applying to the PIC, you may request an internal review from the insurer. The insurer must respond within 28 days. If the internal review upholds the original decision, you may then apply to the PIC. Alternatively, you may request mediation through SIRA’s dispute resolution service. Mediation is a voluntary process where a neutral third party helps both sides reach a settlement. It is often quicker and less adversarial than a formal review.
Medical Disputes and the PIC Pathway
If the dispute involves a medical assessment, for example, whether an injury qualifies as a threshold injury under the Motor Accident Guidelines, you may request a review by the PIC’s medical dispute pathway. This process allows for an independent medical assessment to determine whether the injury meets the threshold for damages. The review is not automatic; you must apply and provide supporting medical evidence. The PIC will not change a decision solely because you disagree with it, it must be based on the law and evidence.
Time Limits and the Importance of Acting Promptly
Time limits apply. You must apply to the PIC within 12 months of the insurer’s final decision. Missing this deadline may prevent you from pursuing a formal review. However, if you have a reasonable excuse for delay, you may apply for an extension. The PIC will consider factors such as whether you were unaware of the decision, received misleading information, or were unable to act due to injury or illness.
Example: A Claimant in the Hunter Region
A pedestrian in Maitland was struck by a car while crossing a road. The driver was using a mobile phone at the time. The insurer denied the claim on the grounds that the injury was not a threshold injury. The claimant obtained a medical report confirming a soft-tissue injury with neurological signs consistent with a spinal nerve-root injury. The claimant applied to the PIC for a review and submitted the medical evidence. The PIC upheld the claim, finding that the injury met the threshold definition under the Motor Accident Guidelines. The claimant was awarded treatment and care benefits and later received damages.
When to Seek Independent Advice
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.