How to Challenge an Insurer's CTP Claim Decision in NSW
If your insurer has denied or reduced your Compulsory Third Party (CTP) claim after a motor accident in New South Wales, you may be able to request an internal review before escalating the matter to the State Insurance Regulatory Authority (SIRA). This article explains the practical steps injured road users in Greater Sydney can take to challenge a claim decision, what evidence to prepare, and how this process differs from formal complaints to SIRA.
The NSW CTP Rules Behind This Question
Under the Motor Accident Injuries Act 2017, insurers must provide a written decision on CTP claims within 28 days of receiving all necessary evidence. If you disagree with the decision, you can request an internal review before contacting SIRA. This process allows insurers to reconsider their decision based on new evidence or a reassessment of the claim.
Key principles include:
- Internal reviews are not guaranteed to change decisions - insurers are not obligated to alter their decision.
- Time limits apply - you must request a review within 28 days of the decision date.
- Evidence is critical - insurers will assess whether your claim meets the legal criteria for compensation.
Practical Steps and Evidence for an Internal Review
To challenge a claim decision, follow these steps:
1. Request an Internal Review
Write to your insurer’s claims department within 28 days of their decision. Your letter should:
- Clearly state your disagreement with the decision.
- Reference the specific section of the claim decision you contest.
- Include any new evidence or clarification you wish to add.
Example: "I dispute your decision to deny my claim for soft tissue injury. My medical records show I sustained a spinal nerve-root injury, which meets the threshold injury definition under the Motor Accident Guidelines. Please reconsider my claim."
2. Prepare Supporting Evidence
Insurers will assess your claim based on:
- Medical records - including reports from doctors, physiotherapists, or specialists.
- Accident details - police reports, witness statements, or photos of the scene.
- Income records - proof of lost wages or reduced earning capacity.
- Insurer correspondence - copies of all previous communications about your claim.
3. Understand the Review Timeline
Insurers must respond to your internal review request within 28 days. If they still deny your claim, you can escalate the matter to SIRA.
How This Differs from Formal SIRA Complaints
Internal reviews are a preliminary step before contacting SIRA. Key differences include:
| Aspect | Internal Review | SIRA Complaint | |--------|----------------|----------------| | Who handles it | Insurer | SIRA | | Time limit | 28 days from decision | 28 days from insurer’s final decision | | Purpose | Reconsider claim on new evidence | Challenge insurer’s decision under CTP laws | | Outcome | May result in revised decision | May lead to mediation or formal review |
Time Limits for Initiating a Review
You must request an internal review within 28 days of the insurer’s decision. If you miss this deadline, you may lose the right to challenge the decision through the insurer’s internal process. Always keep copies of all correspondence to prove you acted within the time limit.
When to Seek Advice
If your insurer refuses to conduct an internal review, or if you’re unsure whether your claim meets the legal criteria, seek advice from a solicitor or legal adviser. They can help you:
- Determine whether your injury qualifies as a threshold injury or whole person impairment.
- Prepare a strong case for your claim.
- Navigate the process of escalating to SIRA.
A Realistic Example
Imagine you were a pedestrian injured in a car accident in Sydney. Your insurer denied your claim, stating your injuries were not serious enough. You request an internal review, providing medical records showing a spinal nerve-root injury. The insurer reviews your claim but still denies it. You then contact SIRA, which may refer your case to mediation or a formal review.
Next Steps
If you’re unsure whether your claim meets the legal criteria or need help preparing evidence, seek professional advice. The process of challenging an insurer’s decision can be complex, and understanding your rights under NSW CTP law is essential.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.