Understanding Insurer Internal Reviews in NSW CTP Claims
If your motor accident compensation claim has been disputed by your insurer, you may be entitled to request an internal review. Under NSW law, this is a formal step that must be taken before escalating the matter to the Personal Injury Commission (PIC) or the State Insurance Regulatory Authority (SIRA). The time limits for initiating an internal review are strict and must be followed carefully to preserve your rights. In Greater Sydney, as elsewhere in NSW, the process is governed by the Motor Accident Injuries Act 2017 and the Motor Accident Injuries Regulation 2017.
Legal Framework for Internal Reviews
The Motor Accident Injuries Act 2017 sets out the framework for handling disputes between claimants and insurers. When an insurer refuses to pay a claim or disputes the level of benefits, the claimant may request an internal review. This is not a new claim, but a formal process to have the insurer reconsider its decision. The review must be requested in writing and must be made within 28 days of receiving the insurer’s written decision. This 28-day period is a fixed legal deadline under the Act.
How Internal Review Time Limits Differ from General Claim Time Limits
It is important to distinguish internal review time limits from the broader time limits for making a motor accident claim. The general time limit to commence a claim for damages under the Motor Accident Injuries Act 2017 is three years from the date of the accident. However, this does not apply to internal review requests. The 28-day internal review deadline is separate and must be met regardless of the three-year claim window. Missing this deadline may prevent you from challenging the insurer’s decision through formal review, which could affect your ability to later seek a determination from the PIC.
Practical Steps to Take if Your Claim Is Disputed
If your insurer has denied or partially denied your claim, you should act promptly. The first step is to obtain a written copy of the insurer’s decision. This document will state the reasons for the denial and must be received before you can begin the internal review process. You must then submit a written request for internal review within 28 days of receiving that letter. The request should clearly state the grounds for dispute and include any supporting evidence.
Evidence That May Support Your Internal Review Request
To strengthen your internal review request, gather and include the following evidence:
- A copy of the motor accident report, if one was filed with police or SIRA
- Medical records from your treating practitioner, including diagnosis, treatment plan, and any functional limitations
- Photographs of the accident scene, vehicle damage, or injuries
- Witness contact details and statements
- Records of lost income, if applicable
- Correspondence with the insurer, including any prior responses
These documents help demonstrate the validity of your claim and the basis for disputing the insurer’s decision.
What Happens After You Submit Your Internal Review Request
Once submitted, the insurer must acknowledge receipt of your request within 14 days. They then have 28 days to complete the internal review and notify you in writing of the outcome. During this time, they must reassess the claim using the same criteria as the initial decision. The insurer may uphold, vary, or reverse its original decision. If the insurer upholds the decision, you may then apply to the Personal Injury Commission for a review.
The Role of the Personal Injury Commission and SIRA
If the internal review does not resolve the dispute, you may apply to the Personal Injury Commission (PIC) for a determination. The PIC is the independent body that resolves disputes about motor accident compensation in NSW. You must apply within 30 days of receiving the insurer’s internal review outcome. SIRA oversees the PIC and ensures compliance with the Motor Accident Injuries Act 2017. SIRA does not make decisions on individual claims but provides guidance and monitors the process.
Hypothetical Example: Internal Review in Greater Sydney
A pedestrian in Sydney’s Inner West was struck by a car in a crosswalk in July 2026. The insurer initially denied a claim for weekly income payments, citing a lack of medical evidence of injury. The claimant obtained a medical report confirming a minor soft tissue injury and a 10% whole person impairment rating. The claimant submitted a written internal review request within 28 days of receiving the denial letter, including the medical report and photographs of the scene. The insurer upheld the decision after internal review. The claimant then applied to the PIC within 30 days of receiving the internal review outcome. This example illustrates how timely action and proper evidence are essential to progressing a dispute.
Important Limitations and Realistic Outcomes
An internal review does not guarantee a change in the insurer’s decision. The insurer is required to reconsider the claim based on the same legal and factual framework, but they may still reach the same conclusion. If the insurer upholds the decision, you must proceed to the PIC to seek a formal determination. You cannot bypass the internal review process. The review is a procedural requirement, not a substitute for a PIC application.
When to Seek Legal Advice
Given the strict time limits and procedural requirements, it is advisable to seek independent advice if you are unsure about the process, the evidence to include, or whether to proceed with an internal review. Legal advice can help you understand your rights under the Motor Accident Injuries Act 2017 and ensure that your request is properly structured and submitted on time.
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