If your insurer has denied your CTP claim because you're returning to daily activities, you're not alone. In New South Wales, insurers must assess claims based on the Motor Accident Injuries Act 2017 and the SIRA guidelines. This article explains what to do if your claim has been denied, how insurers evaluate claims related to daily activities, and your legal options.
What to Do When Your CTP Claim is Denied
If your insurer denies your claim, the first step is to understand the reason. Insurers may deny claims if they believe your injuries don’t meet the threshold injury definition or if they think you’ve returned to your usual activities. Under the Motor Accident Injuries Act 2017, insurers must provide a written explanation of their decision.
You should review the insurer’s letter carefully. If they claim you’ve returned to your usual activities, they may be referring to your ability to perform daily tasks, such as cooking, cleaning, or working. However, the law doesn’t require you to be completely unable to perform these tasks to qualify for benefits. Instead, the focus is on whether your injuries meet the threshold injury criteria.
If you believe the insurer’s decision is incorrect, you can request a review. SIRA provides a process for disputing claims, and you may need to provide additional evidence to support your case.
How Insurers Evaluate CTP Claims Related to Daily Activities
Insurers assess claims based on the Motor Accident Guidelines, which define threshold injuries. These include injuries such as soft tissue injuries, fractures, or spinal nerve-root injuries that produce neurological signs. If your injuries fall within this category, you may be eligible for weekly income payments or treatment and care benefits.
When evaluating claims related to daily activities, insurers may consider whether you’ve returned to your usual routine. However, the law doesn’t require you to be completely unable to perform daily tasks. Instead, the focus is on whether your injuries prevent you from performing your usual work or significantly affect your quality of life.
If your insurer denies your claim because you’ve returned to your usual activities, they may be applying a strict interpretation of the threshold injury definition. In such cases, it’s important to provide evidence that your injuries still meet the criteria for benefits.
Legal Options if Your CTP Claim is Denied
If your insurer denies your claim, you have the right to challenge their decision. You can request a review of the claim through SIRA or seek independent legal advice. In some cases, you may need to provide additional evidence, such as medical records or a report from a medical practitioner, to support your case.
If your claim is denied due to a misunderstanding of the threshold injury definition, you may need to provide a detailed explanation of your injuries and how they affect your daily life. SIRA provides a process for disputing claims, and you may need to submit a written request for a review.
When to Seek Legal Advice
If your insurer denies your claim and you’re unsure how to proceed, it’s important to seek legal advice. A solicitor can help you understand your options and ensure that your claim is assessed fairly. In some cases, you may need to provide additional evidence or challenge the insurer’s interpretation of the law.
What to Do Next
If your insurer has denied your CTP claim because you’re returning to daily activities, you’re not alone. You have the right to challenge their decision and seek compensation if your injuries meet the threshold injury criteria. The next step is to understand the reason for the denial and take action to support your case.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.