Insurer Internal Reviews, What Injured People Need to Know
If your CTP claim was rejected or partially approved, you may have questions about how insurers handle internal reviews. In NSW, insurers must reconsider decisions before escalating disputes to the Personal Injury Commission (PIC) or the State Insurance Regulatory Authority (SIRA). This article explains common concerns, legal boundaries, and practical steps for injured people in Greater Sydney.
How Do Insurers Handle Internal Reviews?
Under the Motor Accident Injuries Act 2017, insurers must conduct an internal review of claim decisions within 28 days of receiving new evidence or a request for reconsideration. This process allows insurers to reassess claims based on updated information, such as additional medical records or revised accident reports. The review must be completed before the insurer can refer the matter to PIC or SIRA.
Common Questions Injured People Ask
- Will the insurer reconsider my claim?
Insurers must review claims internally before escalating disputes. This means they cannot refuse to reconsider your case without first conducting an internal review.
- What evidence can I submit for a review?
You can provide new medical evidence, such as a GP report or specialist opinion, or clarify details about the accident. For example, if your initial claim was based on incomplete information, you can submit a revised accident report or witness statement.
- How long does the internal review take?
Insurers have 28 days to complete the review. If they fail to act within this timeframe, you may have grounds to escalate the matter to PIC or SIRA.
- Can I challenge the insurer’s decision?
Yes, but you must first exhaust the internal review process. If the insurer’s decision remains unchanged, you can request a review by PIC or SIRA. This process involves submitting a formal application and may require medical evidence to support your case.
Practical Steps for Injured People
- Document all communication: Keep copies of emails, letters, and phone calls with the insurer. This helps track the timeline of your claim and ensures you meet deadlines.
- Obtain medical records: If your claim was denied due to a lack of medical evidence, request copies of your medical records from your GP or specialist. These records should detail your injuries, treatment, and recovery progress.
- Seek clarification: If you’re unsure about the insurer’s decision, ask for a written explanation. This helps you understand the reasons for the rejection and identify any gaps in your claim.
- Escalate if needed: If the insurer refuses to reconsider your claim or fails to act within 28 days, you can escalate the matter to PIC or SIRA. This process may involve submitting a formal application and attending a review hearing.
Example Scenario
Imagine you were a pedestrian in a car accident in Sydney’s inner west. Your insurer initially denied your claim, citing a lack of medical evidence. You then submitted a GP report confirming your injuries and requested an internal review. The insurer reviewed your claim and approved it, leading to a settlement. This example illustrates how providing new evidence can lead to a positive outcome.
When to Seek Legal Advice
If your claim is denied or if you’re unsure about the insurer’s decision, it’s important to seek legal advice. A solicitor can help you understand your options, ensure you meet all deadlines, and prepare a strong case for review by PIC or SIRA.
Next Steps
CTP claims can be complex, especially when disputes arise. Understanding the insurer’s internal review process is crucial to protecting your rights. If you’re in Greater Sydney and need assistance with your claim, complete the quick, no obligation enquiry form to request contact about your circumstances.