If your Compulsory Third Party (CTP) claim was denied after an insurer's internal review in Western Sydney, you have options to challenge the decision. This article explains the formal dispute resolution process under NSW law, including how to escalate claims with SIRA and what evidence to prepare. The process applies to all motor accidents in NSW, including those in car parks, private property or work sites, provided the injury meets the legal threshold.
What to Do After an Insurer's Internal Review
Insurers in NSW must first consider internal reviews before escalating disputes to SIRA. Claimants should request a written explanation of the denial, including which CTP benefits were refused and why. Key evidence to gather includes:
- Medical records confirming your injury meets the soft tissue or threshold injury definition
- Accident reports and witness statements
- Proof of income to support claims for weekly payments
- Correspondence with the insurer showing the denial
If the insurer refuses to reconsider, you may submit a formal complaint to SIRA. The Motor Accident Injuries Act 2017 requires insurers to provide a written response within 21 days of receiving a complaint.
SIRA's Role in Resolving Disputes
SIRA oversees CTP claims in NSW and provides guidance on dispute resolution. Their website explains how to:
- Submit a written complaint about denied benefits
- Request a review of medical assessments
- Escalate to the Personal Injury Commission (PIC) for mediation
SIRA's internal review process typically takes 28 days. If the decision remains unchanged, you may seek alternative dispute resolution through the PIC or apply for a review by the NSW Civil and Administrative Tribunal (NCAT).
Formal Dispute Options in Western Sydney
Claimants in Western Sydney have the same dispute options as other NSW regions. These include:
- Requesting a medical dispute review by the PIC
- Applying for mediation through SIRA
- Filing a formal complaint with NCAT
Note that SIRA does not provide refunds for denied claims, but they will review decisions based on the Motor Accident Guidelines. A successful challenge may result in additional weekly payments, treatment benefits or compensation for long-term impairment.
When to Seek Legal Advice
Disputes over denied CTP claims often require legal expertise, especially if:
- The insurer refuses to provide a written explanation
- Medical assessments are disputed
- You need to apply for a review by NCAT
Legal professionals can help prepare formal complaints, challenge incorrect medical opinions, and ensure all evidence meets SIRA's requirements. Remember, time limits apply - you must submit a formal complaint within 21 days of the insurer's final decision.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.