How SIRA Regulates Independent Medical Exams in Regional NSW
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).
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 you're injured in a motor accident in the Illawarra or South Coast regions of New South Wales, you may be asked to undergo an independent medical examination (IME) conducted by your insurer. The New South Wales Motor Accident Injuries Act 2017 and the Motor Accident Guidelines provide the legal framework for these exams, but SIRA (State Insurance Regulatory Authority) has specific rules about how insurers must conduct them in regional areas. This article explains what claimants need to know about SIRA’s oversight of insurer IMEs in Illawarra and South Coast.
What Are SIRA’s Rules on Insurer-Run IMEs?
SIRA oversees the conduct of independent medical exams by insurers under the Motor Accident Injuries Act 2017. For regional areas like Illawarra and South Coast, SIRA has clarified that insurers must follow strict procedural rules to ensure fairness. These include:
- Notice requirements: Insurers must provide claimants with written notice of the date, time, and location of the IME at least 14 days in advance.
- Access to medical records: Claimants have the right to bring their own medical records to the exam and to be accompanied by a representative.
- Independent assessment: The IME must be conducted by a medical practitioner approved by SIRA, not an employee of the insurer.
SIRA’s rules apply equally to metropolitan and regional areas, but claimants in Illawarra and South Coast may face additional challenges due to limited access to medical professionals. Insurers must account for this by ensuring IMEs are conducted in a timely manner.
Practical Steps for Claimants
If you’re asked to undergo an IME, take the following steps to protect your rights:
- Review the notice: Check that the insurer has provided written notice at least 14 days before the exam. If the notice is inadequate, contact SIRA.
- Prepare your records: Gather all medical records, treatment plans, and evidence of your injury. This includes documentation from GPs, specialists, and physiotherapists.
- Request accompaniment: You have the right to be accompanied by a representative, such as a solicitor or a family member.
- Challenge the exam: If you believe the IME is unfair or not conducted properly, you can request a review by SIRA.
Time Limits and Dispute Options
CTP claims must be submitted within 52 weeks of the accident if the injury is a 'threshold injury' (as defined by the Motor Accident Guidelines). If your injury is more severe, you may have longer to claim, but time limits still apply. If you disagree with the outcome of an IME, you can:
- Request a second opinion from a SIRA-approved medical practitioner.
- Appeal to SIRA if you believe the insurer has acted unfairly.
When to Seek Advice
If you’re unsure about your rights during an IME or need help challenging an insurer’s decision, contact a solicitor specialising in NSW CTP claims. Legal advice can help you understand how SIRA’s rules apply to your specific situation, especially if the exam affects your eligibility for benefits or damages.
Final Steps for Claimants
Independent medical exams are a common part of the CTP claims process, but they must be conducted fairly under SIRA’s rules. If you’re in the Illawarra or South Coast regions, ensure your insurer follows the correct procedures. Time limits apply, so act promptly if you believe your rights have been breached. For tailored advice, complete the quick, no obligation enquiry form to request contact about your circumstances.