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 you're involved in a fatal motor accident claim in Western Sydney and disagree with an insurer's decision, understanding your dispute resolution options is critical. Under NSW Compulsory Third Party (CTP) laws, you may pursue mediation through the State Insurance Regulatory Authority (SIRA), request an internal review, or take the matter to court. This article explains how to challenge compensation decisions, the role of SIRA, and practical steps to take when disputes arise.
How SIRA Resolves Disputes Over Fatal Motor Accident Claims
SIRA oversees the CTP scheme and provides a structured process for resolving disputes. If an insurer rejects a claim or offers an amount you believe is unfair, you can request a review of the decision. SIRA's role includes assessing whether the insurer applied the Motor Accident Injuries Act 2017 correctly, particularly regarding threshold injuries, weekly benefits, or lifetime care entitlements.
When a dispute arises, SIRA may:
- Mediate between the claimant and insurer to reach an agreement
- Refer the matter to the Personal Injury Commission (PIC) for a formal review
- Require medical evidence to determine the nature and severity of injuries
Practical Steps for Disputing a Compensation Decision
If you disagree with an insurer's decision on a fatal motor accident claim, take these steps:
- Request a written explanation of the insurer's decision, including the basis for rejecting the claim or the compensation amount.
- Submit a formal dispute to SIRA within 28 days of receiving the decision. Late submissions may be denied.
- Provide evidence such as medical records, accident reports, witness statements, and income records to support your claim.
- Seek legal advice if the insurer refuses to reconsider its decision or if you believe the claim involves complex legal issues.
Time Limits and Legal Pathways
Disputes over fatal motor accident claims must be resolved within strict timeframes. For example:
- You must notify SIRA of a dispute within 28 days of the insurer's decision
- The PIC has 21 days to review a dispute and issue a written response
- Legal action must be initiated within 6 months of the claim being finalized
If the insurer's decision is based on a medical assessment, you may also challenge the medical opinion through the PIC's medical dispute pathway. This involves submitting a second opinion from a registered medical practitioner.
Hypothetical Example: Disputing a Compensation Decision
Consider a scenario where a family of a deceased motorcyclist receives a compensation offer that excludes lifetime care costs. The family disputes the insurer's decision to exclude these costs, arguing that the deceased's dependants require ongoing support. They submit a dispute to SIRA, providing medical evidence of the deceased's injuries and financial records showing the dependants' needs. SIRA reviews the claim and may refer it to the PIC for further assessment.
When to Seek Legal Advice
Disputes over fatal motor accident claims can be complex, especially when they involve:
- Determining the correct application of the Motor Accident Injuries Act 2017
- Challenging medical assessments or injury classifications
- Navigating the PIC's review process
- Understanding the impact of contributory fault or threshold injury rules
Legal professionals can help you assess whether your dispute has merit and guide you through the legal steps required to challenge an insurer's decision.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.