Understanding Insurer-Ordered IMEs in NSW CTP Claims
If you have been involved in a motor accident in Ashfield, NSW, and your CTP insurer has requested an independent medical examination (IME), you may be concerned about time limits. Under NSW law, there is no fixed statutory deadline for attending an IME, but the insurer must give reasonable notice and the claimant must respond in good faith. The Motor Accident Injuries Act 2017 and SIRA’s guidance clarify that delays in attending an IME may affect the processing of benefits, but the insurer cannot refuse to pay benefits solely because of a minor delay, provided the claimant has not unreasonably withheld cooperation.
Legal Framework for IMEs in NSW
Insurer-requested IMEs are governed by the Motor Accident Injuries Act 2017 and the Motor Accident Injuries Regulation 2017. These laws do not prescribe a specific timeframe for attending an IME, but they require that the insurer must give the claimant reasonable notice of the appointment. The claimant must then attend the examination within a reasonable period, which depends on the circumstances, including the nature of the injury, the medical practitioner’s availability, and the claimant’s ability to travel.
SIRA’s guidance confirms that a claimant is not required to attend an IME if it is unreasonable to expect them to do so, such as if the appointment is scheduled during a period of acute injury, hospitalisation, or when medical advice prohibits travel. The insurer must not unreasonably delay or refuse to schedule an IME, and must act in good faith to facilitate timely assessment.
Practical Steps and Evidence to Preserve
To manage an IME request effectively, you should:
- Notify your CTP insurer in writing as soon as possible if you cannot attend the appointment due to medical reasons, travel issues, or other valid concerns.
- Keep a record of all correspondence, including emails, letters, and SMS messages, related to the IME request.
- Provide medical evidence if you are unable to attend, such as a letter from your treating medical practitioner confirming that travel or assessment would worsen your condition.
- If you are asked to attend an IME in a location that is not reasonably accessible, you may request a relocation of the appointment to a nearby facility.
Failure to attend an IME without a reasonable explanation may result in a delay in the assessment of your claim, including treatment and care benefits, weekly income payments, or damages. However, the insurer cannot withhold benefits permanently based on a single missed appointment if the claimant provides a valid reason and cooperates in rescheduling.
Consequences of Missing an IME Appointment
Missing an IME appointment does not automatically invalidate your claim. However, it may impact the insurer’s ability to assess your injury and determine entitlements. If you miss an appointment, the insurer may pause processing benefits until you attend or provide a valid reason for absence.
SIRA’s guidance states that if a claimant fails to attend an IME without a reasonable explanation, the insurer may delay or refuse to pay benefits pending a new assessment. But this does not mean the claim is lost, rescheduling is possible, and the insurer must not act arbitrarily.
A hypothetical example: A claimant in Ashfield was injured in a motor accident on 15 March 2026. The insurer requested an IME on 20 April 2026. The claimant was still recovering from surgery and had a medical certificate from their surgeon stating they were unfit to travel. The claimant notified the insurer by email on 22 April, attached the medical certificate, and requested rescheduling. The insurer delayed rescheduling for over six weeks. In this case, the claimant’s delay was reasonable, and the insurer was required to reschedule promptly. The claim was not compromised.
Disputing IME Delays or Refusals
If you believe your insurer has unreasonably delayed or refused to schedule an IME, or has failed to provide reasonable notice, you may dispute the decision. You can contact SIRA directly to raise a concern. SIRA may investigate and require the insurer to comply with its obligations under the Motor Accident Injuries Act 2017.
You may also seek advice from an independent legal or claims assistance provider. SIRA provides information on how to make a complaint, but it does not represent claimants in disputes.
When to Seek Legal Advice
While there is no fixed time limit for attending an IME, delays in responding to an insurer’s request may affect your claim. If you are uncertain about your obligations, or if the insurer has refused to reschedule an IME despite valid medical evidence, you should seek independent advice.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.