Where a person's only injuries resulting from the accident are threshold injuries, weekly benefits and treatment and care generally cease after 52 weeks (ss 3.11 and 3.28).
Insurers handling Compulsory Third Party (CTP) claims in New South Wales must retain specific evidence during internal reviews to support their decisions. This includes medical records, accident details, and documentation of claimant communications. Understanding these requirements helps claimants navigate disputes effectively.
Legal Framework for Insurer Evidence Retention
Under the Motor Accident Injuries Act 2017 and SIRA guidelines, insurers must maintain records to justify decisions during internal reviews. Section 4.4 of the Act limits benefits for claims where only threshold injuries apply, requiring insurers to document why benefits are restricted after 52 weeks. SIRA’s Making a Motor Accident Claim page confirms insurers must retain evidence supporting all claim decisions, including medical assessments and injury severity evaluations.
Key Evidence Insurers Must Retain
Insurers in Bankstown NSW must keep records such as:
- Medical reports confirming injury diagnosis and treatment
- Accident reports detailing the incident’s circumstances
- Witness statements or statements from the claimant
- Correspondence with the claimant, including dates and responses
- Documentation of any internal review decisions, including reasons for benefit adjustments
These records must be retained to demonstrate compliance with the Motor Accident Injuries Regulation 2017, which mandates transparency in claim assessments. For example, if an insurer denies a claim for soft tissue injury, they must provide clinical evidence from a medical practitioner to support this decision.
How SIRA Guidelines Apply to Disputes
SIRA’s What You Can Claim page outlines that insurers must consider all relevant evidence before denying a claim. If a claimant disputes an insurer’s decision, the insurer must show that their internal review process followed SIRA’s guidelines. This includes:
- Using the Motor Accident Guidelines to assess injury severity
- Documenting how claimant evidence was evaluated
- Explaining why certain benefits were not granted
Insurers failing to retain these records risk breaching their obligations under the CTP scheme. Claimants should request copies of all retained evidence to verify compliance.
Practical Steps for Claimants in Bankstown
If an insurer disputes a claim, claimants should:
- Request a copy of all retained evidence, including internal review notes
- Compare the evidence to SIRA’s guidelines to identify gaps
- Seek independent medical opinions if the insurer’s assessment is unclear
- Consider disputing the decision through the Personal Injury Commission (PIC) if necessary
For instance, if an insurer denies a claim for a soft tissue injury without clinical evidence, the claimant may argue the decision lacks support under the Motor Accident Guidelines. This could lead to a review or escalation to SIRA.
Time Limits and When to Seek Advice
Insurers must complete internal reviews within 28 days of receiving a claim, per SIRA’s Motor Accident Claims guidelines. If a claimant feels their evidence is not being properly considered, they should seek legal advice before the 28-day deadline expires. Delays in disputing decisions may limit options for escalation.
Next Steps for Claimants
If you’re in Bankstown NSW and your insurer is disputing a CTP claim, it’s important to understand what evidence they must retain. Time limits and procedural requirements can affect your ability to challenge a decision. For tailored advice, complete the quick, no obligation enquiry form to request contact about your circumstances.