How CTP Insurers Conduct Surveillance Investigations in NSW
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).
A threshold injury under the Motor Accident Injuries Act 2017 (NSW) includes a soft tissue injury and a psychological or psychiatric injury that is not a recognised psychiatric illness (adjustment disorder and acute stress disorder are the usual examples; s 1.6 and Motor Accident Guidelines Part 5).
Insurer surveillance investigations are a standard practice in NSW Compulsory Third Party (CTP) claims, governed by the Motor Accident Injuries Act 2017 and SIRA guidelines. Under these rules, insurers may investigate claimed injuries and activities to assess claim validity. SIRA explains that this process must balance the insurer’s duty to manage claims with the claimant’s right to fair treatment.
Legal Framework for CTP Surveillance
- SIRA’s guidance outlines that insurers may use reasonable methods to verify injuries, including reviewing medical records, assessing daily activities, and monitoring claimant behavior. These investigations must comply with the
- Motor Accident Injuries Act 2017* and the
- Motor Accident Injuries Regulation 2017*. Insurers cannot use intrusive or unlawful methods, such as accessing private communications without consent.
Key principles include:
- Surveillance must be proportionate to the claim’s circumstances.
- Insurers must document their investigation process.
- Claimants have the right to challenge surveillance methods that breach legal standards.
Practical Steps and Evidence for Claimants
If an insurer conducts surveillance, claimants should:
- Request a written explanation of the investigation’s scope.
- Gather evidence of injury-related limitations, such as medical reports or activity restrictions.
- Document daily routines to demonstrate how the injury affects their life.
SIRA advises that claimants should not avoid surveillance but instead ensure their actions align with their injury’s impact. For example, if a claimant is recovering from a soft-tissue injury, they should not engage in activities that contradict their medical advice.
Time Limits and Dispute Options
CTP claims must be submitted within 52 weeks of the accident if the injury is classified as a threshold injury (per the Motor Accident Guidelines). Insurers may dispute claims by arguing that injuries fall below the threshold or that surveillance reveals inconsistencies.
If a dispute arises, claimants may:
- Request a review by the insurer’s internal team.
- Seek mediation through the NSW Civil and Administrative Tribunal (NCAT).
- Lodge a complaint with the Financial Ombudsman Service (FOS) if the insurer refuses to resolve the issue.
When to Seek Legal Advice
Insurers may use surveillance to challenge claims, especially if they suspect exaggeration or misrepresentation. SIRA recommends consulting a legal professional if:
- Surveillance methods appear unreasonable.
- The claimant feels their rights are being violated.
- The insurer refuses to settle a legitimate claim.
A solicitor can help claimants understand their options and ensure their rights under the CTP scheme are protected.
Example Scenario
Consider a claimant who suffered a soft-tissue injury in Auburn. The insurer investigates by reviewing their social media activity, noting posts about exercising. The claimant explains that their doctor advised against exercise but the insurer disputes the injury’s severity. SIRA’s guidance would support the claimant’s right to challenge the insurer’s interpretation of their medical records.
Next Steps
CTP surveillance investigations are a normal part of the claims process, but they must comply with legal standards. If you’re in Auburn and facing an insurer’s investigation, it’s important to understand your rights and the evidence required to support your claim. Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.