If you're experiencing issues with an insurer's handling of your NSW Compulsory Third Party (CTP) claim, particularly concerning caregiver support or family considerations, you may be able to lodge a complaint with the State Insurance Regulatory Authority (SIRA). This article explains the process, what SIRA considers when assessing complaints, and the evidence needed to support your case.
What Is a SIRA Complaint and When Can You Lodge One?
SIRA oversees the NSW CTP scheme, which requires insurers to pay benefits for injuries caused by motor vehicle accidents. If you believe an insurer has failed to meet its obligations, such as not adequately addressing your family's care needs or delaying payments, you may file a complaint. SIRA will investigate whether the insurer breached its legal duties under the Motor Accident Injuries Act 2017.
To lodge a complaint, you must first exhaust internal insurer channels. Most insurers have a complaints process, and SIRA will consider whether the insurer has resolved your issue satisfactorily. If not, you can submit a formal complaint to SIRA through its online portal or by contacting them directly.
How SIRA Assesses Caregiver and Family Considerations
SIRA evaluates complaints by examining whether insurers have properly considered the impact of an injury on the claimant's family. This includes:
- Whether the insurer has acknowledged the need for caregiver support
- Whether the claimant's dependents or family members have been adequately considered in benefit calculations
- Whether the insurer has acted unreasonably in delaying or denying claims related to family care
For example, if a claimant requires long-term care and the insurer refuses to cover caregiver expenses, SIRA may find the insurer has failed to meet its obligations. SIRA will also assess whether the insurer has followed the Motor Accident Guidelines when determining care needs.
Evidence to Support Your SIRA Complaint
To strengthen your complaint, gather documents such as:
- Medical records showing the need for caregiver support
- Correspondence with the insurer about family care issues
- Evidence of delays in processing claims
- Witness statements from family members or caregivers
SIRA will consider these alongside the insurer's internal records. If your complaint relates to a caregiver's income loss or additional costs, ensure you have documentation of these impacts.
Time Limits and Dispute Options
You must lodge a complaint with SIRA within 12 months of the accident or when the issue arose. If SIRA finds the insurer has acted improperly, it may issue a direction requiring the insurer to pay additional benefits or rectify its handling of the claim. If the insurer disputes the complaint, SIRA may refer the matter to the NSW Civil and Administrative Tribunal (NCAT) for resolution.
When to Seek Legal Advice
While SIRA handles complaints about insurer conduct, complex family or caregiver issues may require legal assistance. A solicitor can help you understand whether your case meets the threshold for SIRA intervention and ensure your complaint includes all relevant evidence.
Next Steps
CTP claims involving family or caregiver considerations can be complex, especially when disputes arise over the insurer's handling of your case. Time limits and legal standards apply, so it's important to act promptly. If you're unsure whether your complaint meets SIRA's criteria, contact a legal professional for guidance.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.