SIRA's Role in Handling Insurer Complaints About Daily Activities
If an insurer in New South Wales (NSW) raises concerns about your ability to return to daily activities after a motor accident, the State Insurance Regulatory Authority (SIRA) oversees how these complaints are addressed. SIRA ensures insurers comply with the Motor Accident Injuries Act 2017 and its regulations when assessing claims. Insurers cannot unilaterally dispute a claimant’s functional recovery without providing evidence that meets legal standards.
What Evidence Do Insurers Need to Support Complaints?
Insurers must back up complaints about a claimant’s ability to return to daily activities with specific evidence. This includes:
- Medical records showing neurological or physical impairments
- Functional capacity assessments from registered medical practitioners
- Evidence of reduced mobility or pain affecting daily tasks
- Documentation of treatment progress or setbacks
Under the Motor Accident Guidelines, insurers must demonstrate that a claimant’s injuries prevent them from performing essential activities like cooking, cleaning, or working. General claims about 'not being able to return to normal' without clinical support are not sufficient.
How Claimants Can Respond to Insurer Complaints
If an insurer disputes your ability to return to daily activities, you should:
- Request a copy of the insurer’s evidence to understand their concerns
- Obtain a second opinion from a medical practitioner familiar with the Motor Accident Guidelines
- Submit updated medical records showing functional recovery
- Seek assistance from a registered claims advisor through SIRA’s free support services
SIRA requires insurers to provide evidence that is 'clear, specific and directly relevant' to the claim. If an insurer fails to meet this standard, claimants can escalate the matter through SIRA’s dispute resolution process.
Time Limits and When to Seek Advice
Insurers must act within 52 weeks of the accident for claims involving only threshold injuries (soft tissue injuries meeting the spinal nerve-root criteria). If a claimant’s injuries exceed threshold level, they may be eligible for ongoing weekly benefits and treatment payments. Time limits for disputing insurer decisions depend on the specific claim type and must be addressed within 28 days of receiving a decision notice.
Claimants should seek legal advice if:
- Insurers refuse to provide evidence for their complaints
- Medical records are misinterpreted or ignored
- The claimant’s ability to return to daily activities is being unfairly assessed
Example of a SIRA-Related Dispute
A claimant who suffered a whiplash injury may be told by an insurer that they cannot return to work. However, if medical records show the claimant has regained full mobility and completed a return-to-work plan, the insurer’s complaint lacks clinical support. In such cases, SIRA will typically require the insurer to revise their assessment.
Next Steps for Claimants
If you’re facing a dispute about your ability to return to daily activities, it’s important to act promptly. SIRA’s guidelines require insurers to provide evidence that is both legally and clinically sound. By understanding your rights and gathering appropriate documentation, you can challenge unfair claims assessments.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.