Common Mistakes When Dealing With Denied CTP Claims
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, you’re not alone. Insurers in Newcastle and Hunter often reject claims due to misunderstandings, incomplete evidence, or procedural errors. Avoid these common mistakes to improve your chances of success:
- Failing to follow the correct claim process: SIRA requires claims to be submitted through the insurer’s formal process. Missing steps like submitting medical records or accident reports can lead to automatic rejection.
- Not documenting injuries properly: Claims for soft-tissue injuries (threshold injuries) require specific evidence, such as medical notes confirming neurological signs or imaging. A lack of documentation can undermine your case.
- Ignoring time limits: You have 52 weeks from the accident date to claim certain benefits. Delays beyond this period may result in lost entitlements, even if injuries persist.
- Assuming fault doesn’t matter: While CTP claims are typically no-fault, insurers may dispute liability in blameless accidents. Always confirm the accident’s legal classification.
How to Challenge an Insurer’s Denial
When an insurer denies a claim, you can:
- Request a written explanation: Insurers must provide reasons for rejection. If the denial is based on incorrect information, this is your chance to correct it.
- Submit additional evidence: If the insurer claims insufficient documentation, provide updated medical records, accident reports, or witness statements. For example, a doctor’s note confirming ongoing treatment for a soft-tissue injury may be critical.
- Appeal through SIRA: If the insurer refuses to reconsider, you can escalate the dispute to the NSW Civil and Administrative Tribunal (NCAT) or the Supreme Court. SIRA’s dispute resolution process outlines steps for this.
The Role of SIRA in Resolving Disputes
SIRA oversees CTP claims in NSW and provides guidance on resolving disputes. In Newcastle and Hunter, claimants should:
- Refer to SIRA’s claim guidelines: The SIRA Motor Accident Claims page explains how to challenge denials and what evidence is required.
- Seek early intervention: SIRA encourages claimants to contact their insurer within 52 weeks of the accident. If you’ve missed this window, explain why and provide supporting evidence.
- Understand your options: SIRA’s What You Can Claim page clarifies benefits like weekly income payments, treatment costs, and rehabilitation support.
A Hypothetical Example
Consider a cyclist in Newcastle who suffered a soft-tissue injury after a collision. The insurer denied the claim, arguing there was no ‘neurological sign’ to qualify as a threshold injury. The claimant later provided a doctor’s note confirming radiculopathy (a specified clinical sign under the Motor Accident Guidelines), which reinstated the claim. This shows how critical accurate medical documentation is.
Next Steps
If your claim has been denied, act quickly. Review the insurer’s reasons, gather additional evidence, and consider escalating the dispute through SIRA or NCAT. Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.