Injury Documentation Checklist for Insurer Disputes in NSW 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 NSW Compulsory Third Party (CTP) motor accident claim is being disputed by an insurer, understanding what injury documentation is required during internal reviews is critical. This article explains the key evidence needed to support your claim, how SIRA guidelines apply, and practical steps to prepare your case in Greater Sydney.
What Injury Documentation is Required During Insurer Internal Reviews?
Insurers must reconsider claims before escalating disputes to the Personal Injury Commission (PIC) or the State Insurance Regulatory Authority (SIRA). To support your case, you must provide:
- Medical records showing the nature and severity of your injuries, including diagnosis, treatment plans, and recovery timelines.
- Accident reports from police, hospitals, or private investigators detailing the incident's circumstances.
- Witness statements from people who saw the accident or can confirm your injuries.
- Photographs of injuries, vehicle damage, and the accident scene.
- Income records proving lost wages or reduced earning capacity.
- Communication with the insurer showing delays or refusal to acknowledge your injuries.
SIRA's guidelines on 'what you can claim' clarify that insurers must assess injuries based on medical evidence, not assumptions. If your claim is denied, you must demonstrate that your injuries meet the threshold injury definition under the Motor Accident Injuries Act 2017.
How SIRA Guidelines Apply to Injury Documentation in Disputes
SIRA's Motor Accident Claims page states insurers must 'consider all relevant evidence' when assessing claims. This includes:
- Spinal nerve-root injuries that produce neurological signs, even if not classified as radiculopathy.
- Threshold injuries requiring specific clinical signs under the Motor Accident Guidelines.
- Documentation of ongoing treatment to support claims for weekly income payments or treatment and care benefits.
If your insurer disputes the severity of your injuries, you must provide medical records from registered practitioners confirming your condition. SIRA's 'Making a Motor Accident Claim' page advises that claims must be 'supported by evidence of injury, not speculation'.
Practical Steps to Prepare Injury Documentation for Disputed CTP Claims
- Gather all medical records from doctors, physiotherapists, and hospitals, including imaging reports and specialist opinions.
- Obtain a detailed accident report from the police or a private investigator, including witness statements.
- Document your injuries with photographs, noting dates and conditions.
- Track income loss with payslips, tax records, or employer statements.
- Keep copies of all correspondence with the insurer, including emails and letters.
- Seek a second medical opinion if your insurer disputes the extent of your injuries.
A hypothetical example: If you suffered a soft-tissue injury after a car accident, your medical records must show neurological signs beyond radiculopathy to qualify as a threshold injury under SIRA guidelines. Without this evidence, insurers may reject your claim.
Time Limits, Disputes and When to Seek Advice
Insurers have 28 days to respond to a claim under the Motor Accident Injuries Act 2017. If they dispute your injuries, you must request an internal review within this timeframe. If the insurer refuses to reconsider, you may need to:
- Escalate the dispute to the PIC or SIRA.
- Request a medical review by a registered practitioner.
- Seek legal advice if your claim is rejected or delayed.
The PIC or SIRA will assess your claim based on the evidence provided. If your claim is denied, you may need to reapply or pursue a new claim under the current scheme.
When to Seek Independent Legal Advice
If your insurer disputes your injuries or refuses to pay benefits, you may need to consult a solicitor. Legal advice can help you:
- Understand your rights under the Motor Accident Injuries Act 2017.
- Prepare a strong case for internal review or dispute resolution.
- Navigate the process of escalating claims to the PIC or SIRA.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.