SIRA Complaints About Insurers: What Changed After 2017 Reforms
If you're in Newcastle or Hunter and have concerns about an insurer's handling of a motor accident claim, the 2017 reforms to NSW’s Compulsory Third Party (CTP) scheme may have altered how complaints are processed. This article explains the legal changes, how they affect insurer obligations, and practical steps for claimants.
How the 2017 Reforms Changed CTP Claims
The 2017 reforms to the Motor Accident Injuries Act 2017 (MAIA) shifted responsibility for claims from the Nominal Defendant to the insurer directly. This means insurers now handle claims under the CTP scheme, including disputes over benefits, treatment, or delays. While the reforms did not explicitly overhaul SIRA’s complaint process, they changed how insurers operate, which can impact how complaints are resolved.
For example, insurers must now provide clearer information about claim outcomes, and claimants can request written explanations for denied benefits. These changes align with SIRA’s role as the regulator of CTP claims, but the exact procedures for lodging complaints remain unchanged from pre-2017.
Practical Steps for Filing a SIRA Complaint
If you believe an insurer has acted unreasonably, follow these steps:
- Document the issue: Keep records of correspondence, claim forms, and any evidence of delays or incorrect payments.
- Contact the insurer: Request a written response to your concerns. Many issues are resolved at this stage.
- Lodge a formal complaint: Use SIRA’s online complaint form or contact them directly. Ensure your complaint includes specific details about the insurer’s actions and how they affected your claim.
- Seek independent advice: A legal professional can help you understand your options, especially if the insurer refuses to cooperate.
Time Limits and Dispute Options
You must lodge a complaint with SIRA within 12 months of the incident or when you became aware of the issue. If the insurer fails to resolve the matter, you may need to escalate the complaint through NSW Civil and Administrative Tribunal (NCAT) or pursue legal action. However, these options are typically reserved for serious breaches of the CTP scheme.
When to Seek Legal Advice
If your complaint involves complex issues like disputed injury assessments, delayed payments, or claims for non-CTP benefits (e.g., pain and suffering), a lawyer can help you navigate the process. Legal advice is also recommended if the insurer threatens to stop payments or refuses to engage.
Next Steps
The 2017 reforms have made insurers more accountable, but the process for lodging complaints with SIRA remains largely unchanged. If you’re in Newcastle or Hunter and need help with a complaint, contact SIRA directly or seek legal guidance to ensure your concerns are addressed properly.
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