Understanding Partial Fault in NSW CTP Claims
In a motor accident in Greater Sydney, if more than one party contributed to the crash, the Motor Accident Injuries Act 2017 (MAIA) allows for shared liability. This means the insurer may assess that you were partly at fault, which can affect the amount of compensation you receive. The law does not require you to be entirely blameless to claim under Compulsory Third Party (CTP) insurance. However, your share of fault may reduce the benefits you are entitled to, including weekly income payments and treatment and care benefits.
How SIRA Manages Disputes in CTP Partial Fault Claims
The State Insurance Regulatory Authority (SIRA) oversees CTP claims in NSW and provides dispute resolution pathways when parties disagree on fault or the value of a claim. If your insurer disputes your claim or your level of fault, you may request an internal review. This is a formal process within the insurer’s own procedures, and you must request it within 28 days of receiving a decision. SIRA does not directly arbitrate disputes but ensures insurers follow the MAIA and Motor Accident Guidelines.
If the internal review does not resolve the dispute, you may apply to the Personal Injury Commission (PIC) for a determination. The PIC handles claims involving disputed fault, injury severity, or entitlement to benefits. You can apply online or by post, and the PIC will assess the evidence and issue a binding decision. This process is free and does not require a solicitor, though legal advice may help you prepare your case.
Practical Steps to Resolve a Dispute
To resolve a dispute over partial fault, begin by gathering and preserving evidence. This includes:
- Medical records showing injury onset and treatment
- Photographic evidence of vehicle damage and scene conditions
- Witness statements, including contact details
- Police reports, if available
- A copy of the insurer’s decision letter
- Details of any prior claims or injury history
If your insurer has assigned a fault percentage, you may challenge it by submitting a written response with supporting evidence. For example, if a driver claims you failed to yield at a traffic light, but you have video footage showing the light was green for your vehicle, that evidence may support a lower fault share.
Medical Evidence and Dispute Outcomes
A medical dispute may arise if the insurer questions the nature or cause of your injury. Under the Motor Accident Guidelines, a claimant may be assessed for a whole person impairment (WPI) if the injury is permanent. If a medical practitioner’s report contradicts the insurer’s assessment, you may request a second opinion or apply to the PIC for a medical dispute determination.
The PIC will review the medical evidence, including imaging reports, clinical assessments, and treatment notes. A decision may be made within 30 to 60 days, depending on complexity. However, a challenge does not guarantee a different outcome. The PIC will base its decision on the evidence, not on preference or claimant sentiment.
Time Limits and Procedural Requirements
Time limits apply to dispute resolution. You must request an internal review within 28 days of receiving the insurer’s decision. If you proceed to the PIC, you must apply within 12 months of the insurer’s initial decision. These deadlines are strict and cannot be extended unless exceptional circumstances apply.
If you have not received a decision within 60 days of an internal review request, you may escalate to the PIC. The PIC may also accept a claim if the insurer has not responded within 90 days of the review request.
When to Seek Independent Advice
Disputes involving partial fault, especially where injury is complex or long-term, may require independent legal advice. A solicitor can help you understand your rights under the MAIA, assess the strength of your evidence, and prepare a submission to the PIC. They can also assist if you believe the insurer has misapplied the Motor Accident Guidelines or failed to consider relevant medical evidence.
Hypothetical Example: Resolving a Shared Fault Dispute
A pedestrian in Sydney’s inner west was struck by a car while crossing a zebra crossing. The driver claimed the pedestrian stepped into the road without looking. The insurer assigned 30% fault to the pedestrian. The pedestrian provided CCTV footage showing the driver had slowed but did not stop, and a medical report confirming a whiplash injury. The pedestrian challenged the fault assessment and submitted the evidence to the insurer. After an internal review, the insurer revised the fault share to 10%. The pedestrian accepted the revised offer.
Next Steps
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.