If you're in Bankstown NSW and believe your motor accident insurer mishandled your return-to-daily-activities claim, you can formally complain to the State Insurance Regulatory Authority (SIRA). This article explains how to file a complaint, what evidence to gather, and how SIRA evaluates insurer conduct under NSW's Compulsory Third Party (CTP) scheme.
What Is a SIRA Complaint About Daily Activities?
SIRA oversees insurers under the Motor Accident Injuries Act 2017. If your insurer refuses to assess your ability to return to work, household tasks, or other daily activities, or if their assessment appears unfair, you can lodge a complaint. SIRA investigates claims of insurers failing to comply with CTP rules, including inadequate support for return-to-activity assessments.
Practical Steps to File a SIRA Complaint
- Gather Evidence: Collect documents showing the insurer's handling of your daily activities claim. This includes:
- Medical reports confirming your injury and functional limitations
- Insurer correspondence about your return-to-activity timeline
- Records of any disputes over your capacity to work or perform daily tasks
- Witness statements or expert opinions if available
- Complete the SIRA Complaint Form: Visit SIRA's complaint page to download the form. Fill it with details of the insurer's actions, including dates, specific issues, and how the conduct affected your claim.
- Submit the Complaint: Send the completed form to SIRA via mail or online. You can also contact SIRA directly by phone to explain your case.
What SIRA Looks For in Daily Activities Claims
SIRA evaluates complaints by checking if insurers followed CTP rules. Key factors include:
- Whether the insurer assessed your ability to return to daily activities in line with the Motor Accident Guidelines
- Whether the insurer provided adequate support, such as vocational rehabilitation or medical referrals
- Whether the insurer's actions conflicted with SIRA's published claims guidance
For example, if an insurer denied a claim for returning to work without first assessing your medical condition, this could constitute a breach of CTP rules.
Time Limits and Dispute Options
You must file a SIRA complaint within 28 days of the insurer's final decision. If SIRA finds the insurer acted improperly, it can order the company to:
- Reassess your claim
- Provide additional benefits
- Correct procedural errors
If SIRA's decision is unsatisfactory, you may escalate the matter to the NSW Civil and Administrative Tribunal (NCAT) for further review.
When to Seek Legal Advice
While SIRA handles complaints about insurer conduct, complex cases may require a solicitor. A lawyer can:
- Help you interpret CTP rules and SIRA guidelines
- Represent you in disputes with insurers
- Ensure your complaint includes all necessary legal arguments
Example Scenario
Consider a claimant in Bankstown who was advised by their insurer they could return to work, but their doctor later confirmed they were unfit. The insurer refused to reconsider the claim. This situation could justify a SIRA complaint, as the insurer failed to properly assess the claimant's medical condition before making decisions about daily activities.
Next Steps
CTP claims and insurer conduct can be complex, especially when daily activities are involved. If you're unsure whether your case meets SIRA's criteria, or if you need help preparing a complaint, complete the quick, no obligation enquiry form to request contact about your circumstances.