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 insurer has denied or reduced your NSW CTP claim, you have legal rights to request an internal review before escalating to SIRA. This article explains the early steps injured road users should take, including how to challenge decisions, what evidence matters, and time limits under the Motor Accident Injuries Act 2017.
Requesting an Internal Review
Under NSW CTP rules, insurers must consider claims under the Motor Accident Guidelines. If you disagree with a decision, you can ask the insurer to review it internally before escalating. This process usually involves:
- Submitting a written request for reconsideration
- Providing additional evidence such as medical records, accident reports, or witness statements
- Waiting for the insurer to respond within the statutory time limits
Insurers must provide a written explanation of their decision, including the legal basis for denying or adjusting benefits. If the insurer refuses to reconsider, you may need to escalate to SIRA.
SIRA's Dispute Resolution Framework
SIRA oversees the CTP scheme and handles disputes between claimants and insurers. When an insurer's internal review is unsatisfactory, you can:
- Lodge a formal dispute with SIRA within 28 days of the insurer's decision
- Request a review of the insurer's interpretation of the Motor Accident Guidelines
- Seek mediation or a formal review by SIRA's dispute resolution team
SIRA has specific rules about what evidence is required to challenge an insurer's decision. For example, medical evidence must show a direct link between the accident and your injuries.
Key Documentation for Disputes
To support a CTP claim dispute, injured road users should gather:
- Medical records showing the nature and severity of injuries
- Police reports or accident statements
- Witness contact details
- Income records to support claims for lost wages
- Correspondence with the insurer
Evidence must directly connect the accident to your injuries and demonstrate that the insurer's decision is legally incorrect. For example, if your claim is denied due to a 'threshold injury' ruling, you may need to show that your injuries exceed the statutory definition.
Time Limits and When to Seek Advice
CTP claims have strict time limits. You must notify the insurer of your claim within 28 days of the accident. If you dispute a decision, you have 28 days from the insurer's response to escalate to SIRA. Delays can jeopardize your right to challenge a decision.
If you're unsure whether your claim meets the legal criteria, seek legal advice early. SIRA's dispute resolution process can be complex, and an experienced solicitor can help you understand your options under the Motor Accident Injuries Act 2017.
Example Scenario
A cyclist in Ashfield was injured in a collision and claimed weekly benefits under the CTP scheme. The insurer denied the claim, arguing the injuries were 'threshold injuries' under the Motor Accident Guidelines. The cyclist requested an internal review, providing medical evidence showing a spinal nerve-root injury with neurological signs. The insurer upheld the decision, so the cyclist escalated to SIRA. SIRA reviewed the medical evidence and determined the injury met the statutory definition, leading to a revised claim.
Next Steps
CTP disputes can be resolved through internal reviews, SIRA mediation, or formal legal action. The available options depend on the accident date, injury type, and claim history. Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.