Medical Assessment Disputes and Time Limits for CTP Claims in NSW
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).
If you're involved in a motor accident claim in New South Wales and facing a dispute over a medical assessment, understanding the time limits under NSW law is critical. The rules governing these disputes are set out in the Motor Accident Injuries Act 2017 (MAIA) and guided by the State Insurance Regulatory Authority (SIRA). This article explains the legal time limits for medical assessment disputes, how SIRA guidelines apply, and what happens if deadlines are missed.
Key Time Limits for Medical Assessment Disputes
Under NSW law, the time limits for disputing a medical assessment depend on the type of claim and when the assessment was conducted. For claims under the Compulsory Third Party (CTP) scheme, the following apply:
- Initial medical assessments: A medical practitioner must complete an assessment within 28 days of the accident if the injury is classified as a 'threshold injury' (see below). If the assessment is not completed within this timeframe, it may be considered untimely.
- Disputing the assessment: If you disagree with the medical assessment, you must request a review within 28 days of receiving the report. Failure to act within this period may result in the assessment being accepted as final, even if it is later challenged.
- Review by the Personal Injury Commission (PIC): If a dispute reaches the PIC, the review must be completed within 28 days of the initial assessment. Delays beyond this period may lead to procedural sanctions or reduced compensation.
SIRA Guidelines on Medical Assessment Disputes
SIRA provides detailed guidance on handling medical assessments under the CTP scheme. According to SIRA's Making a Motor Accident Claim page, medical assessments must be completed promptly to ensure they reflect the current state of the injured person's condition. Delays can affect the accuracy of the assessment and the eligibility for benefits.
SIRA also outlines that disputes over medical assessments must be resolved through the PIC's internal review process. This includes submitting evidence such as medical records, expert opinions, and witness statements to challenge the original assessment. The PIC will consider whether the assessment was completed in accordance with the guidelines and whether it accurately reflects the injury.
Consequences of Missing Time Limits
Missing time limits for medical assessments can have serious consequences for your claim. Under the MAIA, the PIC has discretion to refuse to review a disputed assessment if it was not completed within the required timeframe. This means that even if the assessment is later found to be incorrect, the claimant may lose the right to challenge it.
For example, if a medical assessment is not completed within 28 days of the accident, the PIC may consider it untimely and refuse to review it. This can result in the claimant being unable to access benefits such as weekly income payments or treatment and care benefits.
Practical Steps for Medical Assessment Disputes
If you are involved in a medical assessment dispute, take the following steps:
- Review the medical report: Ensure the assessment includes all relevant details about your injury, treatment, and prognosis. If the report is incomplete or unclear, request a revision.
- Request a review within 28 days: If you disagree with the assessment, submit a written request for a review to the PIC within 28 days of receiving the report. Include any supporting evidence, such as additional medical records or expert opinions.
- Seek independent medical advice: Consult a medical practitioner who specializes in personal injury to review the assessment. Their opinion can be submitted to the PIC as part of your dispute.
- Act quickly: Time is critical. Delays in requesting a review or submitting evidence can result in the PIC refusing to consider your dispute.
When to Seek Legal Advice
If you are unsure about the time limits for your medical assessment dispute or need help preparing a review request, seek legal advice. A solicitor can help you understand your rights, ensure all deadlines are met, and represent you before the PIC.
Final Steps for Claimants
Medical assessment disputes under NSW CTP claims are time-sensitive. Missing deadlines can result in the loss of benefits or the inability to challenge the assessment. If you are unsure about the time limits or need assistance with your dispute, complete the quick, no obligation enquiry form to request contact about your circumstances.