How NSW CTP Insurers Handle Internal Reviews
In New South Wales, insurers managing Compulsory Third Party (CTP) claims must follow strict rules when reviewing decisions. Under the Motor Accident Injuries Act 2017, insurers are required to consider all evidence before making a claim outcome. If a claimant disagrees with a decision, they can request an internal review before escalating the matter to the Personal Injury Commission (PIC) or the State Insurance Regulatory Authority (SIRA). This process is critical for resolving disputes about claim value, medical evidence, or benefit calculations.
Practical Steps to Challenge an Insurer's Decision
To dispute an insurer's decision, claimants in Western Sydney should:
- Submit a written request for an internal review within 28 days of receiving the decision (per SIRA guidelines)
- Include all relevant evidence such as medical records, accident reports, and witness statements
- Clarify the grounds for dispute (e.g., disagreement with a medical opinion or benefit calculation)
Insurers must respond in writing within 21 days, explaining their decision. If the claimant remains unsatisfied, they can escalate the matter to SIRA.
Time Limits and Dispute Resolution
CTP claimants must act quickly. While there's no fixed time limit for internal reviews, delays can reduce the chances of a successful challenge. SIRA's guidelines state that claims must be submitted within 52 weeks of the accident for weekly benefits. If a claimant disputes a decision after this period, they may need to provide additional evidence to justify an extension.
Disputes often arise over:
- Medical evidence - insurers may challenge the link between the accident and injuries
- Benefit calculations - disagreements over weekly payments or treatment costs
- Claimant's ability to work - disputes about whether injuries prevent employment
When to Seek Legal Advice
If an insurer's decision appears to ignore key evidence or misinterpret SIRA guidelines, claimants should consider legal advice. A solicitor can:
- Review the insurer's reasoning against the Motor Accident Guidelines
- Challenge the validity of medical opinions used to assess claim value
- Help escalate disputes to the PIC or SIRA
Legal assistance is particularly valuable when disputes involve complex medical evidence or when an insurer refuses to consider new information.
Example: Disputing a Weekly Benefit Decision
A claimant in Western Sydney received a decision that their weekly benefits would stop after 52 weeks, despite ongoing treatment. They submitted additional medical records showing that their injuries had not fully healed. The insurer conducted an internal review but maintained the decision. The claimant then escalated the matter to SIRA, where the dispute was resolved by re-evaluating the medical evidence.
Next Steps
CTP claimants in Western Sydney should act promptly to challenge decisions. While internal reviews are the first step, legal advice can help ensure all options are explored. Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.