What to Do When an Insurer Denies Your CTP Claim in NSW (Greater Sydney)
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 has been denied by an insurer, you need to take immediate steps to protect your rights and entitlements under NSW law. The Motor Accident Injuries Act 2017 (MAIA) governs CTP claims in New South Wales, and the process for dealing with a denied claim is governed by the rules of the State Insurance Regulatory Authority (SIRA). In Greater Sydney, injured road users have a limited time to respond to a denial and may need to take legal action to challenge the decision.
Understanding the CTP Claim Denial Process
When a CTP claim is denied, the insurer may claim that the injury does not meet the threshold injury criteria, that the claimant has not provided sufficient evidence, or that the claimant has contributed to the accident. Under the MAIA, the insurer must provide a written explanation of the denial and the reasons for the decision. In some cases, the insurer may also request additional information or evidence to support the claim.
Practical Steps to Take After a CTP Claim is Denied
If your CTP claim has been denied, you should take the following steps:
- Review the denial letter: Make sure you understand the reasons for the denial and the evidence the insurer is requesting.
- Gather evidence: Collect all relevant evidence, including medical records, accident reports, witness statements, and photographs of the accident.
- Respond to the denial: If the insurer has requested additional information, respond in writing and provide the evidence you have.
- Seek legal advice: If the insurer denies your claim without a valid reason, you may need to seek legal advice to challenge the decision.
How SIRA Handles Denied CTP Claims
SIRA is the regulatory body that oversees the CTP insurance scheme in NSW. If your claim has been denied, you may need to contact SIRA to challenge the decision. SIRA has a process for reviewing denied claims, and you may be able to submit a written request for a review. In some cases, you may also need to take legal action to challenge the denial.
Time Limits for Responding to a Denied CTP Claim
Under NSW law, there are time limits for responding to a denied CTP claim. If the insurer denies your claim, you have a limited time to respond. In some cases, you may need to take legal action within a specific period to challenge the denial. It is important to act quickly and seek legal advice if you are unsure about the next steps.
When to Seek Legal Advice
If your CTP claim has been denied, you may need to seek legal advice to challenge the decision. A solicitor who specialises in CTP claims can help you understand your options and take the necessary steps to protect your rights. In some cases, you may also need to take legal action to challenge the denial.
Conclusion
If your CTP claim has been denied, you need to take immediate steps to protect your rights and entitlements under NSW law. The process for dealing with a denied claim is governed by the rules of the State Insurance Regulatory Authority (SIRA). In Greater Sydney, injured road users have a limited time to respond to a denial and may need to take legal action to challenge the decision. Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.