Understanding Insurer Internal Reviews in NSW
If your insurer has denied or reduced your Compulsory Third Party (CTP) claim, you may be able to request an internal review before escalating the matter to the Personal Injury Commission (PIC) or the State Insurance Regulatory Authority (SIRA). This process allows insurers to reconsider their decision based on new evidence or a reassessment of the claim.
NSW CTP Rules Behind the Process
Under the Motor Accident Injuries Act 2017, insurers must provide a written explanation for claim decisions. If you disagree with the outcome, you can ask the insurer to review its decision. This applies to all CTP claims in NSW, including those involving drivers, passengers, pedestrians, cyclists, and motorcyclists in Auburn and other areas.
Practical Steps to Challenge an Insurer's Decision
To dispute an insurer's decision, follow these steps:
- Request an internal review: Write to the insurer formally, stating your disagreement and providing evidence to support your case.
- Gather evidence: Include medical records, accident reports, witness statements, and any documentation showing the injury's impact on your daily life.
- Seek clarification: If the insurer's decision is unclear, ask for a detailed explanation of how the claim was assessed.
Evidence That Matters Most
Insurers often rely on medical evidence to assess claims. Key documents include:
- Medical reports confirming the injury's severity and treatment
- Accident reports from police or witnesses
- Income records showing lost wages or reduced earning capacity
- Photographs of the accident scene or vehicle damage
Time Limits and Dispute Options
You must request an internal review within 28 days of receiving the insurer's decision. If the review outcome is unsatisfactory, you can escalate the matter to the PIC or SIRA. However, note that a review does not guarantee a change in the decision. The insurer may still uphold its original assessment.
When to Seek Legal Advice
If the insurer refuses to review its decision or if you're unsure how to proceed, consult a solicitor. Legal advice can help you understand your options, prepare a stronger case, and ensure compliance with NSW CTP rules.
Example: Disputing a Soft-Tissue Injury Claim
Consider a scenario where an insurer denies a claim for a soft-tissue injury (e.g., whiplash) based on a medical report lacking specific clinical signs. The claimant could request an internal review, providing additional evidence such as a follow-up report from a specialist or evidence of ongoing symptoms. This demonstrates the importance of thorough documentation in challenging decisions.
Next Steps
CTP claim decisions can depend on the accident date, injury type, and evidence submitted. To request contact about your circumstances, complete the quick, no obligation enquiry form.