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 an injured motor vehicle claimant in Armidale NSW facing delays from your insurer over return-to-daily-activities (RTDA) assessments, you have legal options under NSW CTP law. This article explains how to formally complain to the State Insurance Regulatory Authority (SIRA) about insurer obstruction, what evidence to gather, and when to seek legal advice.
SIRA's Role in CTP Claims
SIRA oversees the NSW Compulsory Third Party (CTP) scheme, ensuring insurers comply with the Motor Accident Injuries Act 2017. Insurers must assess RTDA within 28 days of receiving medical evidence, per SIRA guidelines. Delays or refusal to allow return to daily activities without medical justification may constitute regulatory misconduct.
Filing a SIRA Complaint
To complain about insurer delays, follow these steps:
- Contact your insurer in writing (email or letter) requesting an RTDA assessment within 28 days.
- Document the response - note any refusal to assess, delays, or refusal to allow return to activities.
- Lodge a complaint with SIRA via their online portal or by post. Use the form titled 'Complaint about an insurer's conduct' on the SIRA website.
- Include supporting evidence such as medical reports, correspondence with your treating practitioner, and proof of insurer delays.
SIRA will investigate within 21 days and notify you of their findings. If your complaint relates to an insurer's failure to comply with RTDA assessment timelines, SIRA may issue a formal notice or fine.
Evidence to Support Your Claim
When disputing insurer delays, gather:
- Medical records showing your injury and RTDA status.
- Insurer correspondence proving delays in assessing your case.
- Witness statements from healthcare professionals or family members.
- Proof of daily activity restrictions (e.g., doctor's notes limiting work or household tasks).
Example: If your insurer refuses to allow you to return to work despite medical evidence of recovery, this could support a complaint about obstructing your RTDA.
SIRA's Handling of RTDA Disputes
SIRA evaluates complaints by checking:
- Whether the insurer followed the Motor Accident Guidelines for RTDA assessments.
- Whether the insurer's actions breached the CTP scheme's time limits.
- Whether the claimant's medical evidence supports their RTDA status.
If SIRA finds the insurer acted unreasonably, it may order the insurer to:
- Conduct an RTDA assessment.
- Adjust your weekly benefits.
- Provide additional treatment and care benefits.
Time Limits and Next Steps
You must lodge a SIRA complaint within 28 days of the insurer's last response. If your claim involves disputes over RTDA assessments, consider:
- Requesting a review of your RTDA assessment through your insurer.
- Seeking independent medical opinion if your insurer refuses to allow return to activities.
- Consulting a specialist solicitor if your insurer ignores SIRA's findings.
When to Seek Legal Advice
Contact a solicitor if:
- Your insurer refuses to conduct an RTDA assessment.
- You face financial hardship due to delayed benefits.
- You believe your claim is being unfairly denied.
Legal professionals can help you:
- Apply for compulsory legal aid if eligible.
- Challenge insurer decisions through the NSW Civil and Administrative Tribunal (NCAT).
- Pursue damages claims if your injury meets the threshold injury criteria.
Next Steps
CTP claims depend on the date of your accident, injury severity, and insurer conduct. If your insurer is delaying your return to daily activities in Armidale NSW, act promptly. Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.