If an insurer in New South Wales is delaying or denying compensation for your ability to return to daily activities after a motor accident, you may be able to raise a complaint with the State Insurance Regulatory Authority (SIRA). This article explains the legal framework behind SIRA complaints, the evidence needed to support your case, and the process for addressing insurer delays under the NSW Compulsory Third Party (CTP) scheme.
What SIRA Does in CTP Claims
SIRA oversees the NSW CTP scheme, which provides statutory benefits for injuries caused by motor vehicle accidents. Under the Motor Accident Injuries Act 2017, insurers must cover treatment costs, weekly income payments, and other benefits if your injuries meet specific thresholds. If an insurer refuses to allow you to return to daily activities or denies compensation, SIRA can investigate their decision.
Steps to File a SIRA Complaint
To complain about an insurer's handling of your claim, follow these steps:
- Contact the insurer directly first to request a written explanation for their decision.
- Submit a formal complaint to SIRA via their online portal or by mail. You must include:
- A copy of your claim form
- Evidence of the insurer’s refusal to allow daily activities
- Medical records showing your injury and recovery progress
- Any correspondence with the insurer
- Provide details of the delay (e.g., how long the insurer has refused to pay benefits)
SIRA will review your complaint and may request additional information from the insurer or you. They aim to resolve disputes within 60 days, though complex cases may take longer.
Evidence That Matters for SIRA Complaints
SIRA requires clear evidence to support your complaint. Key documents include:
- Medical records showing your injury diagnosis and recovery timeline
- Accident reports from police or witnesses
- Insurer correspondence (emails, letters) showing delays in processing your claim
- Proof of daily activity restrictions (e.g., doctor’s notes limiting your ability to work or perform routine tasks)
- Evidence of financial impact (e.g., income loss due to inability to work)
If your insurer disputes the severity of your injury, SIRA may refer your case to a medical expert for assessment under the Motor Accident Guidelines.
Time Limits and Dispute Options
You must file a SIRA complaint within 12 months of the accident date, unless the insurer’s delay extends this period. If SIRA rules against the insurer, they may issue a binding decision requiring the insurer to pay outstanding benefits.
If you disagree with SIRA’s outcome, you can:
- Appeal to the NSW Civil and Administrative Tribunal (NCAT)
- Seek legal advice to explore further options
When to Seek Legal Advice
Talk to a solicitor if:
- The insurer refuses to pay benefits for more than 52 weeks (after which weekly payments are generally capped under the Act)
- You believe the insurer has misinterpreted your injury’s severity
- You need help drafting a complaint or negotiating with the insurer
Example Scenario
Imagine you were in a car accident in Albury and suffered a soft-tissue injury. Your insurer denies weekly payments, claiming you’ve returned to daily activities. You submit medical records showing ongoing pain and limited mobility. SIRA investigates and finds the insurer’s decision was unreasonable, ordering them to pay the owed benefits.
Next Steps
CTP claims depend on the accident date, injury type, and insurer actions. If you’re facing delays or denials in Albury, contact SIRA directly or seek legal advice to ensure your rights are protected. Complete the quick, no obligation enquiry form to request contact about your circumstances.