What Changed in NSW CTP Law After 2017 for SIRA Complaints
The Motor Accident Injuries Act 2017 (MAIA) replaced the previous Motor Accidents Compensation Act 1999 and introduced a new framework for motor accident compensation in New South Wales. This reform significantly changed how claims are managed and how disputes with insurers are handled through the State Insurance Regulatory Authority (SIRA). For claimants in Greater Sydney and across NSW, the shift means that SIRA now oversees a more structured and transparent process for addressing insurer conduct, including delays, denial of benefits, or failure to comply with statutory obligations.
Under the new scheme, claimants have a clearer pathway to raise concerns about insurer actions. SIRA’s role has evolved from a passive regulator to an active dispute resolution body. Insurers are now required to follow specific procedures under the Motor Accident Injuries Regulation 2017 and the Motor Accident Injuries Guidelines, which set out expectations for handling claims, communicating with claimants, and processing entitlements.
How SIRA’s Complaint Process Works Now
After 2017, SIRA established a formal process for claimants to raise complaints about insurer conduct. This process is now the primary route for addressing issues such as failure to pay weekly income payments, refusal to approve treatment, or delays in processing claims. The process is available to all claimants, regardless of whether they are claiming statutory benefits or pursuing a damages claim.
To make a complaint, a claimant must first contact the insurer and request a resolution. If the insurer does not respond within 21 days, or if the response is unsatisfactory, the claimant may then submit a formal complaint to SIRA. SIRA will assess whether the insurer has breached its obligations under MAIA or the regulations. If a breach is found, SIRA may require the insurer to take corrective action, such as paying outstanding benefits, approving treatment, or providing a written explanation.
SIRA’s complaint process is not a substitute for legal action. It does not determine entitlement to damages or assess impairment. However, it provides a direct mechanism to address conduct issues that may otherwise delay or prevent access to compensation.
Practical Steps and Evidence That Matter
When raising a complaint with SIRA about an insurer, claimants should gather and preserve evidence that supports their concerns. This includes:
- A copy of the insurer’s written response (if any)
- Medical reports showing treatment needs and ongoing injury
- Records of correspondence with the insurer
- Pay slips or tax returns showing loss of income
- Photographs of the accident scene or vehicle damage
- Witness contact details and statements
SIRA does not investigate claims on their merits. It only reviews whether the insurer followed the correct procedures. Therefore, the focus is on process, not injury severity or fault.
For example, if a claimant was denied a treatment approval for physiotherapy despite a medical practitioner’s recommendation, and the insurer failed to provide a written reason within 14 days, that could constitute a breach of the insurer’s duty under MAIA. SIRA would assess whether the insurer met its statutory obligations to respond in a timely and documented manner.
Time Limits and Dispute Options
There is no fixed time limit to make a complaint to SIRA, but delays may affect the ability to obtain a remedy. Insurers must respond to a claim within 14 days of receiving a request for information, and SIRA expects claims to be processed in a timely way. If a claimant waits more than 12 months to raise a complaint, SIRA may decide not to investigate due to the age of the issue.
If a claimant disagrees with SIRA’s decision on a complaint, they may request a review by SIRA’s internal review panel. If the review upholds the original decision, the claimant may then apply to the NSW Civil and Administrative Tribunal (NCAT) for a review of the decision. This is a limited review and does not allow a full re-examination of the claim.
When to Seek Independent Advice
The 2017 reforms did not change the legal rights of claimants, but they did clarify the roles of SIRA and insurers. Claimants should not assume that SIRA will resolve all issues with insurers. The process is designed to address conduct, not to determine whether a claim is valid or how much compensation is owed.
If a claimant believes they are entitled to damages, or if the insurer has refused to pay statutory benefits despite a clear injury, they may need to seek legal advice. SIRA does not assess impairment, assess fault, or determine entitlement to damages. These matters remain subject to legal proceedings.
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