If your CTP claim has been denied, retaining the right evidence is critical to challenge the decision. Under NSW law, claimants must preserve records that demonstrate the accident, injuries, and insurer liability. This guide explains what evidence matters, how SIRA's rules apply, and steps to take when a claim is rejected.
Why Evidence Matters in CTP Claim Disputes
When an insurer denies a claim, they must provide a reason based on the Motor Accident Injuries Act 2017 and SIRA guidelines. Common grounds for denial include disputes over injury severity, fault, or eligibility for benefits. To challenge this, you must prove:
- The accident occurred as described
- Injuries were caused by the accident
- You meet the legal definition of a 'threshold injury' or other claimable condition
Key Evidence to Preserve
- Medical Records: All documents from doctors, physiotherapists, and hospitals, including diagnosis reports, treatment plans, and recovery timelines. SIRA requires evidence of 'injuries resulting from the accident' to qualify for benefits.
- Accident Scene Documentation: Photos of the vehicle damage, road conditions, and any visible injuries. Witness statements from people who saw the incident are also vital.
- Insurer Correspondence: Save all emails, letters, and forms from the insurer. Note any deadlines or conditions they impose.
- Income and Expenses: Proof of lost wages, medical bills, and other costs. SIRA's 'What You Can Claim' page outlines eligible expenses.
- a Medical Certificate: A doctor's statement linking your injuries to the accident. This is essential for proving 'threshold injury' under the Motor Accident Guidelines.
How SIRA's Rules Apply to Denied Claims
SIRA's guidelines state that benefits are limited to 'injuries resulting from the accident'. If your claim is denied, review the insurer's reasoning against the Motor Accident Injuries Act 2017. For example, if your injury is classified as a 'threshold injury' (like a soft tissue injury), benefits may stop after 52 weeks unless you have a whole person impairment rating.
Steps to Challenge a Denial
- Request a Review: Write to the insurer explaining why your claim should be reconsidered, citing specific evidence.
- Contact SIRA: If the insurer refuses to review, contact SIRA directly. They can mediate disputes and ensure compliance with the law.
- Seek Legal Advice: A solicitor can help you challenge the denial through the NSW Civil and Administrative Tribunal (NCAT) if needed.
Time Limits and Next Steps
You have 52 weeks from the accident date to claim benefits for threshold injuries. If your claim is denied after this period, you may no longer be eligible for weekly payments. However, you can still pursue a dispute if new evidence emerges.
Example Scenario
A cyclist in Western Sydney is denied a claim after a minor collision. They retain medical records showing soft tissue injuries, photos of the accident, and correspondence from the insurer denying coverage. By cross-referencing these with SIRA's guidelines, they challenge the denial and secure a review.
When to Seek Help
If the insurer refuses to reconsider your claim or you're unsure about your options, contact a legal professional. While this article provides general guidance, your circumstances may require tailored advice.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.