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).
CTP insurers in New South Wales may investigate claimed injuries during disputes, and claimants must understand what to expect. This article explains the legal framework, practical steps, and dispute resolution processes under the Motor Accident Injuries Act 2017 and SIRA guidelines.
What CTP Insurers May Investigate
CTP insurers have a duty to assess claims fairly, including verifying the nature and extent of injuries. Surveillance may involve reviewing medical records, monitoring daily activities, or checking compliance with treatment plans. SIRA guidelines state insurers must act reasonably and not unreasonably withhold benefits (SIRA, Motor Accident Claims, 2026). While surveillance is permitted, it must be proportionate to the claim and not interfere with the claimant’s recovery.
Practical Steps for Claimants
If an insurer requests additional information or monitors activities, claimants should:
- Document all medical treatments and keep records of appointments
- Maintain a diary of daily activities, including rest periods and mobility
- Preserve evidence of income loss or care needs
- Respond to insurer requests in writing, citing relevant SIRA guidelines
Insurers may also request access to medical reports or consult with medical practitioners. Claimants should ensure all communications are clear and dated to establish a record of cooperation.
Time Limits and Dispute Resolution
CTP claims must be submitted within 52 weeks of the accident (MAIA s 4.4), though extensions may apply for complex cases. If an insurer disputes a claim, claimants can:
- Request a written explanation of the dispute
- Seek a review by the Personal Injury Commission (PIC) within 28 days of receiving the insurer’s decision
- Lodge a formal objection with the NSW Civil and Administrative Tribunal (NCAT) if the PIC’s decision is unsatisfactory
Claimants should note that disputes over surveillance practices must be resolved through these formal channels. SIRA advises claimants to seek independent legal advice if they believe surveillance is excessive or unlawful.
Example Scenario
A claimant recovering from a soft-tissue injury may be asked to provide detailed activity logs. While this is a legitimate part of the assessment process, insurers must ensure their requests are reasonable and not used to challenge the claimant’s credibility without proper justification.
When to Seek Legal Advice
If an insurer’s surveillance appears to target the claimant’s mental health, financial status, or ability to work, it may indicate a dispute over the claim’s validity. Legal advice should be sought if:
- Surveillance requests are overly intrusive or repetitive
- The insurer refuses to provide a written explanation
- The claimant believes their rights under the MAIA are being violated
CTP disputes often require careful navigation of SIRA guidelines and statutory obligations. Understanding the insurer’s investigation process is essential to protecting your claim.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.