What to Do When a CTP Insurer Investigates Your Claim
Where a person's only injuries resulting from the accident are threshold injuries, weekly benefits and treatment and care generally cease after 52 weeks (ss 3.11 and 3.28).
If you're involved in a motor accident in NSW and your CTP insurer is conducting surveillance to assess your injury claim, it's important to understand what evidence you should retain. Insurers have a legal right to investigate claims, but they must do so within the boundaries of the Motor Accident Injuries Act 2017 and SIRA guidelines. This article explains what records to keep, how to respond to surveillance, and when to seek legal advice.
Legal Framework for CTP Surveillance Investigations
CTP insurers are entitled to investigate claims to verify the validity of injuries and ensure compliance with the scheme. Under the Motor Accident Injuries Act 2017, insurers must act reasonably and not unreasonably withhold benefits. SIRA’s Motor Accident Claims guidelines (https://www.sira.nsw.gov.au/claims/motor-accidents) state that insurers may request documentation to assess the nature and extent of injuries. This includes medical records, activity logs, and evidence of daily living challenges.
Insurers may also use surveillance to observe your behavior, such as whether you are engaging in activities that contradict your injury claims. However, they cannot invade privacy or use intrusive methods beyond what is reasonably necessary to assess the claim.
Practical Steps and Evidence to Retain
When a CTP insurer is investigating your claim, you should retain the following evidence:
- Medical records: Keep all medical reports, treatment records, and correspondence with healthcare providers. These documents must be retained for at least 52 weeks under the Motor Accident Injuries Regulation 2017.
- Activity logs: Document your daily activities, including rest periods, mobility limitations, and any assistance required. This helps demonstrate how your injury affects your lifestyle.
- Witness statements: If witnesses observed the accident or your condition, obtain their statements. SIRA guidelines emphasize that independent evidence can support your claim.
- Photographs and videos: If your injury involves visible damage or mobility issues, retain photographs of the injury site and any equipment used to manage your condition.
- Insurer correspondence: Keep copies of all communications with the insurer, including claims forms and responses to requests for information.
Time Limits and Dispute Options
CTP insurers must notify claimants of their decision within 28 days of receiving a complete claim under the Motor Accident Injuries Act 2017. If you disagree with the insurer’s assessment, you may request a review or escalate the matter to the NSW Civil and Administrative Tribunal (NCAT). SIRA’s guidelines state that claimants have the right to challenge decisions that affect their benefits or entitlements.
When to Seek Legal Advice
If your insurer’s investigation becomes unreasonable or you are unsure how to respond, consult a solicitor. Legal professionals can help you understand your rights under the CTP scheme and ensure you retain all necessary evidence. Remember, every claim depends on its own facts, and the outcome may vary based on the circumstances of your case.
Next Steps
CTP insurers have the right to investigate claims, but they must do so within the bounds of the law. By retaining the right evidence and understanding your rights under the Motor Accident Injuries Act 2017, you can better navigate the claims process. If you need assistance with your specific circumstances, complete the quick, no obligation enquiry form to request contact about your case.