How NSW CTP Insurers Handle Internal Reviews of Claim Disputes
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 CTP claim is disputed by the insurer, understanding the internal review process is critical. NSW insurers must reconsider decisions before escalating to the Personal Injury Commission (PIC) or SIRA. This article explains how insurers handle disputes, using practical examples from Auburn.
NSW CTP Rules Behind Internal Reviews
Under the Motor Accident Injuries Act 2017, insurers must provide a written explanation for claim decisions. If a claimant disagrees, they can request an internal review within 28 days of receiving the decision. This process allows insurers to reassess claims based on new evidence or misinterpretations of medical reports.
Key rules include:
- Insurers must respond to internal review requests within 28 days
- Claimants must submit written evidence supporting their case
- SIRA guidelines require insurers to consider all relevant medical documentation
Practical Steps for Disputed Claims
When disputing a claim, focus on these actionable steps:
- Request a written explanation of the insurer's decision
- Gather medical records showing ongoing treatment
- Document communication with the insurer
- Seek independent medical opinions if needed
In Auburn, claimants often dispute decisions about weekly income payments or treatment benefits. For example, if an insurer refuses to cover physiotherapy after a car accident, you can request an internal review by submitting a letter referencing SIRA's guidelines on treatment benefits.
Time Limits and When to Seek Advice
Insurers must respond to internal reviews within 28 days. If they fail to act, you can escalate to the PIC or SIRA. However, time limits apply:
- 28 days to request an internal review
- 28 days for the insurer to respond
- 5 years from the accident date to claim compensation
If your claim involves a dispute over medical evidence or weekly payments, seek legal advice before the 28-day review period expires. In Auburn, some claimants have successfully challenged decisions by submitting detailed medical timelines showing ongoing impairment.
Example from Auburn
A claimant in Auburn disputed an insurer's refusal to cover a 52-week treatment benefit. The insurer initially cited 'no threshold injury' but later reviewed the claim after the claimant submitted a revised medical report showing spinal nerve-root injury. This example highlights how clear evidence can influence internal reviews.
Next Steps
CTP claims depend on timing, evidence, and legal interpretation. If your insurer disputes your claim, act quickly to request an internal review. For complex disputes involving medical evidence or weekly payments, legal advice can help ensure your rights are protected.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.