Understanding Insurer Internal Reviews in NSW CTP Claims
If you have been involved in a motor accident in New South Wales and your CTP insurer has made a decision you dispute, such as denying a claim, limiting benefits, or rejecting a treatment request, you may have the right to request an internal review. Under the Motor Accident Injuries Act 2017 (NSW), insurers are required to review a disputed decision internally before you can escalate the matter to the Personal Injury Commission (PIC) or the State Insurance Regulatory Authority (SIRA).
This internal review process is not optional. It is a formal step under NSW law that must be completed before you can seek external review. The insurer must give you a written response to your internal review request, and they must do so within a timeframe set by law. Knowing the legal time limits for this process is critical to protecting your rights.
Legal Time Limits for Internal Reviews under NSW Law
The Motor Accident Injuries Act 2017 (NSW) does not set a fixed time limit for insurers to complete an internal review. However, the law requires that an insurer must not unreasonably delay a review. The absence of a statutory deadline means that the review must be conducted within a reasonable timeframe, based on the complexity of the issue and the evidence provided.
SIRA, the NSW government body that oversees CTP claims, states that an internal review should be completed as soon as practicable. While there is no set number of days, delays of more than 60 days may be considered unreasonable, particularly if the insurer has not provided a clear reason for the delay. If an insurer fails to respond within a reasonable time, you may proceed to escalate the dispute to the Personal Injury Commission (PIC) without waiting for their decision.
What to Do If an Insurer Fails to Respond Within a Reasonable Time
If your insurer does not respond to your internal review request within a reasonable timeframe, typically considered to be 60 days from the date of your request, you may treat the review as denied and proceed to the next step. You are not required to wait indefinitely. The law allows you to escalate the dispute to the PIC, which has the authority to review and determine the matter.
Before escalating, you should document all communications with the insurer, including the date you submitted your internal review request, any correspondence received, and any evidence of delays. Keep copies of emails, letters, and notes of phone calls. This record will be essential if you need to demonstrate that the insurer failed to act within a reasonable time.
Practical Steps and Evidence That Matter
To support your internal review request, you should provide the insurer with clear and complete evidence. This includes:
- A copy of the medical report from your treating practitioner detailing your injuries and treatment plan.
- A record of your weekly income loss, including payslips or a letter from your employer.
- A copy of the accident report, if one was filed with police or the insurer.
- Photographs of the accident scene, vehicle damage, or injuries, if available.
- Details of any witnesses to the accident.
The insurer must consider all this evidence when reviewing your claim. If they reject your request without properly addressing the evidence, you may have grounds to challenge their decision at the PIC.
When to Seek Independent Legal Advice
An internal review does not guarantee a change in the insurer’s decision. The insurer may uphold their original decision, even if new evidence is submitted. If you believe the insurer’s decision is incorrect or unreasonable, you may need to seek independent advice before escalating to the PIC.
The PIC process is separate from the internal review. It allows you to present your case to an independent tribunal, which may order the insurer to pay benefits, approve treatment, or reconsider a damages claim. However, the PIC will not hear your case until you have exhausted the internal review process, unless the insurer has failed to respond within a reasonable time.
Hypothetical Example: Delayed Internal Review
For example, if you submitted an internal review request on 15 May 2026, and the insurer had not responded by 20 July 2026, you could reasonably conclude that the delay was unreasonable. At that point, you could notify the insurer in writing that you are escalating the dispute to the PIC, and begin preparing your submission. The PIC would then assess whether the insurer’s failure to respond within a reasonable timeframe (in this case, over 60 days) was a breach of their obligations under the Motor Accident Injuries Act 2017.
Next Steps and the Role of the Personal Injury Commission
If you decide to escalate, you must do so within the time limits set by law for making a claim. The general time limit for starting a claim in NSW is three years from the date of the accident. However, for disputes involving internal reviews, the clock starts from the date you were notified of the insurer’s decision, or, if there was no response, from the date you reasonably concluded the review had been denied.
You may also need to apply for a medical dispute determination through the PIC if your treatment is being refused or limited. The PIC can review medical evidence and determine whether a treatment is reasonable and necessary. This process is separate from the internal review but often occurs in parallel.
Final Considerations
Every claim depends on its own facts. The timing of an internal review, the nature of the dispute, and the evidence available will determine whether a delay by the insurer is considered unreasonable. There is no automatic right to compensation simply because a review was delayed. The outcome depends on the facts, evidence, and applicable law.
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