If your insurer in Albury NSW is refusing to allow you to return to daily activities after a motor accident, you may have grounds to complain to the NSW Motor Accident Insurance Regulatory Authority (SIRA). This article explains how to file a complaint, what evidence to gather, and how SIRA handles disputes about return-to-activities decisions.
What to Do If Your Insurer Refuses to Allow Return to Daily Activities
Under NSW law, insurers must allow injured claimants to return to daily activities if their medical condition permits. If your insurer denies or restricts this, you can raise a complaint with SIRA. The process involves:
- Reviewing your claim documentation - Check if your insurer has approved or denied treatment, income support, or return-to-activities plans. SIRA will assess whether the insurer followed the Motor Accident Injuries Act 2017 and Motor Accident Guidelines.
- Gathering evidence - Collect medical records, treatment plans, and any correspondence with your insurer. SIRA will evaluate whether your insurer’s decision aligns with the guidelines for returning to daily activities.
- Filing a formal complaint - Use SIRA’s online complaint form or contact them directly. Your complaint should detail the insurer’s refusal, the impact on your daily life, and any evidence supporting your case.
What Evidence Matters for a SIRA Complaint About Return to Daily Activities
SIRA requires specific evidence to resolve disputes about return-to-activities decisions. Key documents include:
- Medical reports - From your treating doctor or physiotherapist, showing your ability to perform daily tasks.
- Insurer correspondence - Emails or letters confirming your insurer’s refusal to approve return-to-activities.
- Witness statements - From family, employers, or carers describing your daily limitations.
- Photographs or videos - Of your home or workplace showing how your injury affects daily activities.
SIRA will compare your insurer’s decision with the Motor Accident Guidelines, which outline when and how claimants can return to daily activities. If your insurer’s refusal is not supported by the guidelines, SIRA may intervene.
How SIRA Handles Complaints About Return to Daily Activities in Albury NSW
SIRA’s role is to ensure insurers comply with the Motor Accident Injuries Act 2017. When you complain, SIRA will:
- Assess the insurer’s decision - Against the Act and guidelines.
- Request additional information - From your insurer or medical practitioners.
- Issue a binding decision - If the insurer’s refusal is found to be incorrect, SIRA may direct the insurer to approve return-to-activities or adjust benefits.
SIRA typically aims to resolve complaints within 60 days, though complex cases may take longer. If you’re unsure about your insurer’s decision, seek advice before filing a complaint.
When to Seek Legal Advice About Return to Daily Activities
While SIRA handles complaints about insurer decisions, you may need a solicitor if:
- Your insurer refuses to pay for necessary treatment.
- You believe your injury meets the threshold for long-term benefits.
- Your return-to-activities decision affects your ability to work or care for dependants.
A solicitor can help you understand your rights under the Motor Accident Injuries Act 2017 and ensure your complaint to SIRA is complete.
Next Steps After a SIRA Complaint
If your complaint to SIRA is resolved in your favour, your insurer must act on the decision. If the outcome is unsatisfactory, you may need to escalate the matter through NSW Civil and Administrative Tribunal (NCAT) or pursue a court claim. Always keep copies of all documents related to your claim and complaint.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.