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 disputing an insurer's decision in a New South Wales motor accident claim, understanding how the 2017 reforms changed SIRA's role is critical. The reforms restructured how complaints are handled, altered insurer obligations and introduced new procedures for resolving disputes. This article explains the key changes, how insurers have adapted their practices in Western Sydney, and practical steps for claimants seeking to challenge decisions.
Key Changes to SIRA Complaints After 2017
The 2017 reforms to NSW Compulsory Third Party (CTP) laws significantly altered how claimants can challenge insurer decisions. Under the Motor Accident Injuries Act 2017, SIRA now has clearer authority to investigate complaints about insurer conduct. Insurers must now provide detailed written reasons for denying claims, a change from previous practices where vague or incomplete explanations were common.
A major shift was the introduction of a mandatory 28-day time limit for insurers to respond to claims. This means delays in processing claims are now a stronger basis for complaints. SIRA also introduced a new 'complaint resolution pathway' requiring insurers to engage in mediation before formal complaints are escalated. This change has led to more structured dispute resolution in Western Sydney, where many claims involve complex injuries and long-term treatment needs.
How Insurer Practices Have Evolved
Since the 2017 reforms, insurers have adjusted their approach to claims management. One notable change is the increased use of 'threshold injury' assessments to determine eligibility for weekly benefits. Insurers now apply stricter criteria to evaluate whether injuries meet the soft-tissue definition under the Motor Accident Guidelines. This has led to more disputes over treatment benefits, particularly in cases involving chronic pain or neurological symptoms.
Insurers have also become more selective in approving 'lifetime care' claims, requiring detailed medical evidence of long-term impairment. In Western Sydney, where many claims involve cyclists and pedestrians, this has resulted in more contested decisions. Claimants now need to ensure their medical records clearly document the nature and duration of injuries, as insurers are more likely to challenge claims lacking this evidence.
Steps for Lodging a SIRA Complaint
If you believe an insurer has mishandled your claim, follow these steps: First, review the insurer's written response to ensure it includes all required details under the 2017 reforms. If you're unsatisfied, submit a formal complaint to SIRA within 28 days of receiving the decision. Your complaint must include:
- A copy of the insurer's decision
- Evidence of your injuries (medical reports, treatment records)
- Proof of financial impact (income records, medical bills)
SIRA will then assign your complaint to an investigator. While there's no fixed timeline for resolution, most complaints are addressed within 90 days. If SIRA upholds your complaint, the insurer must rectify their decision within 14 days. This process has led to increased accountability, particularly in cases where insurers previously delayed or denied claims without clear justification.
Time Limits and Dispute Options
Claimants must act quickly. Under the Motor Accident Injuries Act 2017, you have 52 weeks from the accident date to claim weekly benefits for threshold injuries. For non-threshold injuries, the time limit is 10 years from the accident. Missing these deadlines can permanently bar you from certain benefits. If you're disputing an insurer's decision about your injury's severity, you can request a 'review of assessment' through SIRA. This process allows an independent medical expert to reassess your condition.
If disputes escalate, claimants may need to seek legal advice. While SIRA handles complaints about insurer conduct, complex cases involving workers' compensation overlaps or interstate claims may require specialist input. In Western Sydney, where many claims involve private property accidents or car park incidents, the location of the accident can affect how insurers assess liability.
When to Seek Legal Advice
The 2017 reforms introduced new obligations for insurers, but they also created more opportunities for claimants to challenge decisions. If you're unsure whether your complaint meets SIRA's requirements, or if your insurer has refused to engage in mediation, it's wise to consult a solicitor. Legal professionals can help you navigate the updated procedures, ensure all required documentation is submitted, and challenge decisions that fail to comply with the new rules.
Practical Example
Consider a claimant who suffered a soft-tissue injury in a car park. The insurer denied weekly benefits, arguing the injury didn't meet the 'threshold injury' definition. Under the 2017 reforms, the claimant could challenge this by providing medical evidence of neurological signs, such as reduced reflexes or tingling. SIRA would then assess whether the insurer's decision aligned with the Motor Accident Guidelines. This example highlights how the reforms have made it easier for claimants to dispute decisions based on specific medical criteria.
Next Steps
The 2017 reforms have significantly changed how SIRA handles complaints about insurers. While the process is more structured, it also requires claimants to meet specific criteria for lodging complaints. If you're unsure whether your circumstances fall within the new rules, or if your insurer has refused to comply with updated procedures, it's important to seek guidance. Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.