Where a person's only injuries resulting from the accident are threshold injuries, weekly benefits and treatment and care generally cease after 52 weeks (ss 3.11 and 3.28).
If your CTP claim has been denied in New South Wales, understanding the evidence you need to retain is critical. The NSW Motor Accident Injuries Act 2017 and SIRA guidelines outline what insurers must consider when assessing claims. This article explains the evidence to keep, how to challenge a denial, and next steps for claimants in Balmain NSW.
What Evidence to Keep When a CTP Claim Is Denied
When an insurer denies a claim, you must preserve all records that support your case. Key evidence includes:
- Medical records: Detailed reports from doctors, specialists, and physiotherapists confirming your injuries, treatment, and recovery timeline. SIRA guidelines state that medical evidence must show a direct link between the accident and your injuries.
- Accident reports: Police reports, witness statements, and photos of the scene are essential. These help establish the circumstances of the collision and any contributing factors.
- Witness details: Names, contact information, and statements from witnesses who saw the accident.
- Correspondence with the insurer: Save all emails, letters, and forms exchanged with the insurer. These may reveal inconsistencies or delays in processing your claim.
- Income and employment records: Proof of lost wages, reduced earning capacity, or additional expenses like transport or home modifications.
- Medical imaging and test results: X-rays, MRIs, or scans that document your injuries.
How SIRA Guidelines Apply to Denied Claims
- SIRA’s
- Making a Motor Accident Claim* page explains that insurers must assess claims based on the
- Motor Accident Injuries Act 2017* and the
- Motor Accident Guidelines*. If your claim is denied, review the insurer’s reasons against the guidelines. For example:
- Threshold injuries: If your injuries fall under the soft-tissue category (e.g., whiplash), the insurer may argue they are not serious enough. SIRA clarifies that injuries must meet specific clinical criteria, such as spinal nerve-root damage or radiculopathy, to qualify.
- Time limits: Claims for injuries only (not whole-person impairment) may be limited to 52 weeks under the Act. If your claim exceeds this period, you may need to demonstrate ongoing consequences.
- Fault and contributory negligence: Insurers may dispute liability if they claim you contributed to the accident. SIRA’s What You Can Claim page outlines how fault is assessed in NSW.
Steps to Take if Your Claim Is Denied
- Review the denial letter: Insurers must provide a written explanation for rejecting a claim. If the reasoning is unclear or contradicts SIRA guidelines, you may need to request clarification.
- Dispute the denial: Use the insurer’s internal review process. SIRA’s Making a Motor Accident Claim page details how to challenge a decision, including submitting new evidence or requesting a reassessment.
- Seek independent medical opinion: If the insurer disputes the severity of your injuries, obtain a second opinion from a specialist. This can help demonstrate that your condition meets the threshold for compensation.
- Consider legal advice: If the insurer refuses to reconsider or delays payment, consult a solicitor. Legal experts can help you navigate disputes and ensure your rights under the Act are protected.
Example: A Balmain Claimant’s Experience
A Balmain resident, injured in a car accident, was denied a claim for soft-tissue injuries. She retained all medical records, including a specialist’s report confirming radiculopathy, which met the threshold under SIRA guidelines. After disputing the denial and providing additional evidence, the insurer eventually approved her claim. This highlights the importance of thorough documentation.
Next Steps and When to Seek Help
If your claim is denied, act quickly. SIRA’s guidelines emphasize that evidence must be submitted within a reasonable time, though there is no strict deadline. However, delays can weaken your case. For claimants in Balmain, the key is to:
- Preserve all evidence related to the accident and injuries.
- Challenge the denial using SIRA’s processes.
- Seek legal advice if the insurer refuses to reconsider.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.