If your Compulsory Third Party (CTP) claim has been denied or disputed by an insurer in New South Wales, you have options to challenge the decision. This article explains how to request an internal review, what evidence matters, and when to escalate disputes to the Personal Injury Commission (PIC) or SIRA. It focuses on practical steps for claimants in Auburn and the legal rules governing CTP disputes under the Motor Accident Injuries Act 2017.
How to Challenge a Denied CTP Claim
When an insurer denies a CTP claim, the first step is to request an internal review. Under NSW law, claimants must submit a written request to the insurer explaining why the decision should be reconsidered. This process is outlined in the Motor Accident Injuries Regulation 2017 and SIRA guidelines. You should:
- Clearly state the reason for disputing the decision (e.g., incorrect assessment of injuries, missed benefits)
- Provide supporting evidence such as medical records, accident reports, and witness statements
- Reference SIRA's guidelines on what claims are eligible
Insurers must respond to internal reviews within 21 days. If the review upholds the denial, you may need to escalate the matter to the PIC or SIRA.
Dispute Resolution Options in Auburn
If internal review fails, claimants can pursue these options:
1. Personal Injury Commission (PIC) Review
The PIC handles disputes about claim eligibility and benefit calculations. To apply, submit a written request to the PIC within 6 months of the insurer's final decision. The PIC will review your claim based on:
- Medical evidence confirming injuries meet SIRA's threshold criteria
- Proof of financial impact (e.g., lost income, out-of-pocket expenses)
- Documentation of the accident (e.g., police reports, CCTV footage)
The PIC's decision is binding unless appealed to SIRA.
2. SIRA Review
If the PIC upholds the denial, you can request a review from SIRA. SIRA will consider:
- Whether the insurer applied the correct legal standards under the Motor Accident Injuries Act 2017
- Whether the claimant's injuries meet the 'threshold injury' definition in the Motor Accident Guidelines
- Whether the claimant is entitled to additional benefits beyond the 52-week statutory limit
SIRA's review is the final step in the CTP dispute process.
Key Evidence for CTP Disputes
To challenge a denied claim, gather:
- Medical records: Highlighting injuries that meet SIRA's threshold criteria (e.g., soft tissue injuries with neurological signs)
- Accident details: Including dates, locations, and witness statements
- Financial records: Showing lost income or out-of-pocket costs
- Insurer correspondence: Documenting all communications with the insurer
For example, if your claim was denied due to a 'threshold injury' assessment, provide medical evidence showing spinal nerve-root damage with neurological signs, as outlined in the Motor Accident Guidelines.
Time Limits for CTP Disputes
Act quickly, as time limits apply:
- Internal review: Must be requested within 21 days of the insurer's decision
- PIC review: Must be submitted within 6 months of the insurer's final decision
- SIRA review: Must be requested within 6 months of the PIC's decision
If you miss these deadlines, you may lose the right to challenge the insurer's decision.
When to Seek Legal Advice
Consider consulting a solicitor if:
- The insurer refuses to provide a written explanation for the denial
- You're unsure whether your injuries meet SIRA's threshold criteria
- You need help preparing a dispute submission to the PIC or SIRA
A lawyer can help you understand your options and ensure your claim meets all legal requirements.
Example: Disputing a Threshold Injury Denial
Imagine you were in a car accident and suffered a soft tissue injury. The insurer denied your claim, claiming it's not a 'threshold injury.' You can challenge this by:
- Submitting medical records showing neurological signs (e.g., tingling, numbness)
- Referencing SIRA's guidelines on spinal nerve-root injuries
- Requesting an internal review to argue the injury meets the definition
If the insurer still denies the claim, you can escalate to the PIC for a review of the medical assessment.
Next Steps for Claimants
If your CTP claim has been denied, start by requesting an internal review. Gather all relevant evidence and follow the time limits. If the dispute isn't resolved, you can escalate to the PIC or SIRA. Every claim depends on its own facts, so it's important to act promptly and seek advice if needed.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.