What Is an Insurer Internal Review in NSW CTP Claims?
When an insurer in New South Wales denies or reduces a claim for motor accident injuries, the injured person may request an internal review. This is a formal process within the insurer’s own procedures to reconsider the decision. In Bathurst and across NSW, this step is often the first practical response to a disputed claim. It allows the claimant to present additional evidence or clarify misunderstandings before escalating to the Personal Injury Commission (PIC) or the State Insurance Regulatory Authority (SIRA).
The internal review is not a court or tribunal hearing. It is a review by the insurer’s own claims team, often involving a different assessor than the original decision-maker. The process is governed by the Motor Accident Injuries Act 2017 and the Motor Accident Injuries Regulation 2017, which set out the rights and obligations of both the claimant and insurer during dispute resolution.
What Questions Should Injured People Ask During an Internal Review in Bathurst?
Injured people in Bathurst often ask the following questions when disputing a CTP claim:
- Why was my claim denied or reduced?
- What evidence did the insurer rely on to make that decision?
- Can I submit new medical reports, accident details, or witness statements to support my claim?
- Is there a time limit to request an internal review?
- What happens if the insurer upholds their original decision?
These questions are not optional. They form the basis of a meaningful review. The insurer must provide a written response to the internal review request, including reasons for any decision. If the insurer refuses to change their position, the claimant may then apply to the Personal Injury Commission (PIC) for a formal determination.
How to Request an Internal Review of a Disputed CTP Claim in NSW
To request an internal review in NSW, follow these steps:
- Write a formal letter to the insurer, clearly stating that you are requesting an internal review of the decision to deny or reduce your claim.
- Include your claim reference number, full name, date of accident, and a brief summary of the injury and treatment received.
- Attach any new or previously unsubmitted evidence, such as updated medical reports, a letter from your treating practitioner, or photographs of the accident scene.
- Submit the request by post, email, or online through the insurer’s claims portal, if available. Keep a copy of all correspondence.
- Allow the insurer 28 days to respond. The Motor Accident Injuries Regulation 2017 requires insurers to provide a decision within this timeframe.
The request must be made in writing. Verbal requests are not sufficient. Insurers are not required to accept a review if the claim has already been closed, but they may still consider it if new evidence is provided.
What Evidence Is Needed to Support a Claim During an Insurer Dispute Review?
The strength of a claim during an internal review depends on the quality and relevance of the evidence submitted. Key evidence includes:
- Medical reports from your treating practitioner, including assessments of injury severity, treatment plan, and impact on daily life.
- A record of all medical treatment received since the accident, including dates, procedures, and outcomes.
- A statement from a witness who observed the accident, if available.
- Photographs of the vehicle damage, road conditions, or scene of the accident.
- A copy of the police report, if one was filed.
- Evidence of income loss, if you are claiming weekly income payments.
SIRA’s guidance confirms that medical evidence is central to determining eligibility for treatment and care benefits, weekly income payments, and damages. If the insurer disputes the injury’s connection to the accident, a medical report that clearly links the injury to the motor vehicle incident is essential.
Time Limits, Disputes and When to Seek Advice
There is no fixed statutory deadline to request an internal review, but delays may affect your ability to pursue a claim later. If the insurer upholds their original decision, you have 12 months from the date of the written refusal to apply to the Personal Injury Commission (PIC).
The internal review process does not pause the 12-month PIC application period. If you wait too long, you may lose the right to seek a formal determination.
A common mistake is to assume that an internal review will change the insurer’s decision. It may not. The insurer may still refuse to pay, and you will need to proceed to the PIC. However, the review provides a chance to clarify issues, correct errors, and strengthen your case.
If you are unsure whether to proceed with an internal review, or if you have already been denied benefits, it is advisable to seek independent legal advice. A solicitor experienced in CTP claims can assess whether your claim meets the statutory thresholds, whether the insurer’s reasoning is legally sound, and whether you have grounds to challenge the decision.
Hypothetical Example: A Claimant in Bathurst
A 42-year-old woman in Bathurst was involved in a rear-end collision at a traffic light in April 2025. She reported neck and back pain immediately after the accident. Her GP referred her to a physiotherapist and later to a specialist, who diagnosed a soft-tissue injury to the cervical spine. The insurer initially accepted liability but denied her claim for weekly income payments, stating she had returned to work part-time and was not incapacitated.
She requested an internal review, submitted a letter from her specialist confirming ongoing pain and restricted mobility, and provided her employment records showing a 20% reduction in hours. The insurer upheld their original decision. She then applied to the PIC within 12 months, supported by the new evidence.
This example illustrates how an internal review can be used to gather and submit stronger evidence, even if the outcome remains unchanged.
Next Steps: When to Contact a Professional
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