If you're experiencing delays from your insurer in processing daily activity recovery claims after a motor accident in Armidale, NSW, you may have grounds to raise a complaint with the State Insurance Regulatory Authority (SIRA). This article explains the legal framework, evidence needed, and steps to formally lodge a complaint under NSW's Compulsory Third Party (CTP) scheme.
What Evidence Supports a SIRA Complaint About Daily Activity Delays
To file a complaint with SIRA, you must demonstrate the insurer has failed to meet its obligations under the Motor Accident Injuries Act 2017 (MAIA). Key evidence includes:
- Medical records showing your injury and recovery timeline
- Communication with the insurer (emails, letters) indicating delays in processing claims
- Documentation of daily activities (e.g., mobility assessments, therapist notes)
- Proof of insurer's refusal to cover treatment or delay in approving care plans
SIRA requires claims to be supported by evidence of the insurer's failure to act in accordance with the MAIA. For example, if your insurer refuses to cover physiotherapy sessions critical to your recovery, this could constitute a breach of duty.
How SIRA Handles Complaints About Daily Activity Recovery Timelines
SIRA's complaint process focuses on whether insurers have:
- Failed to act within statutory timeframes (e.g., delays beyond 52 weeks for weekly benefits)
- Refused reasonable treatment without proper justification
- Disagreed with medical assessments without providing evidence
When you lodge a complaint, SIRA will review:
- Your claim history with the insurer
- The insurer's internal processes for assessing daily activity recovery
- Whether the insurer has adhered to the MAIA's requirements for treatment and care benefits
If SIRA finds the insurer has acted unreasonably, it may require the insurer to reconsider its decision or provide a formal response.
Steps to Lodge a SIRA Complaint About Daily Activity Recovery
- Gather all relevant documents (medical records, correspondence, activity logs)
- Visit SIRA's claims page to review the complaint process: SIRA Motor Accident Claims
- Submit a written complaint via SIRA's online portal or by post
- Include specific details about the insurer's failure to process your daily activity recovery claim
- Request a response within 28 days of lodging the complaint
Note: SIRA may request additional information or schedule a review of your medical records. It's important to respond promptly to any requests to avoid delays in resolution.
Time Limits and When to Seek Legal Advice
Under the MAIA, insurers must act reasonably in assessing claims. If your insurer has delayed or refused to cover essential daily activity recovery treatments, you may have a valid complaint. However, time limits apply:
- Statutory benefit periods for weekly payments end after 52 weeks if only threshold injuries are involved
- Dispute resolution timelines require prompt action to avoid procedural bars
If your claim involves complex medical assessments or disputes about your injury's severity, consider seeking legal advice. A solicitor can help ensure your complaint meets all legal requirements and deadlines.
Example of a SIRA Complaint Scenario
Imagine a claimant who suffered a soft-tissue injury in Armidale. Their insurer refuses to cover physiotherapy sessions deemed essential for daily activity recovery. The claimant gathers medical records showing the therapy is necessary and lodges a SIRA complaint. SIRA reviews the insurer's refusal and finds it lacks justification, leading to a revised claim assessment.
Next Steps for Claimants
If your insurer has not acted reasonably in processing your daily activity recovery claim, you have the right to raise a complaint with SIRA. By following the outlined steps and providing clear evidence, you can challenge the insurer's decision and seek a fair resolution. Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.