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).
The 2017 reforms to New South Wales' Compulsory Third Party (CTP) motor accident compensation scheme introduced significant changes to how complaints about insurers are handled, particularly in regional areas. These reforms, under the Motor Accident Injuries Act 2017 (MAIA), shifted the focus from fault-based claims to a no-fault system, altering how injured parties interact with the State Insurance Regulatory Authority (SIRA). This article explains the practical implications of these changes for regional NSW claimants seeking to raise concerns about insurer conduct.
What Changed in SIRA's Handling of Insurer Complaints After 2017?
The 2017 reforms replaced the previous Motor Accidents Compensation Act 1999 (MACA) with the MAIA, which governs all CTP claims in NSW. Key changes affecting SIRA complaints include:
- Shift to no-fault claims: Under the MAIA, injured parties can claim compensation regardless of fault, reducing the need to prove fault in disputes. This affects how SIRA assesses complaints about insurer delays or denied claims.
- Streamlined complaint procedures: SIRA now requires complaints to be lodged within 52 weeks of the accident (or 10 years for certain claims) under the MAIA. Regional claimants must ensure they meet these deadlines, as delays may limit their ability to challenge insurer decisions.
- Greater emphasis on documentation: SIRA now prioritizes evidence such as medical records, accident reports, and insurer correspondence when evaluating complaints. This change ensures claims are assessed based on factual records rather than subjective arguments.
How Have Regional NSW Claimants' Experiences Evolved?
In regional NSW, the reforms have led to more structured processes for lodging complaints. SIRA has introduced dedicated support for regional claimants, including extended hours at local offices and online portals to submit claims. However, some claimants report longer wait times for responses compared to metropolitan areas, highlighting the need for proactive communication with SIRA.
A practical example: A regional claimant who suffered a soft-tissue injury after a collision may now need to provide detailed medical records to support a complaint about delayed treatment payments. Under the MAIA, SIRA evaluates whether the injury meets the 'threshold injury' criteria outlined in the Motor Accident Guidelines, which requires specific clinical signs.
What Documentation Is Required for a SIRA Complaint About an Insurer?
When lodging a complaint with SIRA, claimants must provide:
- Medical records confirming the injury (e.g., imaging, specialist reports)
- Accident reports from police or witnesses
- Correspondence with the insurer (e.g., claim forms, refusal letters)
- Proof of income or expenses if seeking financial compensation
- Evidence of insurer delays or refusal to pay (e.g., timelines, communication logs)
These documents help SIRA determine whether the insurer has acted in accordance with the MAIA and whether the claimant’s complaint is valid.
Time Limits and Dispute Resolution Options
Under the MAIA, claimants must lodge complaints with SIRA within 52 weeks of the accident (or 10 years for certain claims). Missing this deadline may result in the claim being dismissed. For disputes over claim decisions, SIRA offers a formal review process, which may involve an independent assessor or mediation.
If a claimant is unsure about their options, they should seek advice from a legal professional or SIRA’s regional offices. The reforms have made the process more structured, but individual circumstances still require careful evaluation.
When to Seek Legal Advice
While SIRA provides resources for resolving complaints, complex cases, such as disputes over long-term care needs or overlapping workers’ compensation claims, may require legal assistance. A solicitor can help claimants navigate the MAIA’s requirements and ensure their rights are protected under the new system.
Next Steps for Regional Claimants
If you’re in regional NSW and have concerns about your insurer’s conduct, start by gathering all relevant documentation and lodging a complaint with SIRA within the 52-week deadline. If you need guidance on the process or have questions about your specific case, complete the quick, no obligation enquiry form to request contact about your circumstances.