Understanding the Issue: Insurer Refusal to Acknowledge Return to Daily Activities
If your insurer in Greater Sydney refuses to acknowledge your return to daily activities after a motor accident, you may have grounds to file a complaint with the State Insurance Regulatory Authority (SIRA). This situation commonly arises when an insurer disputes the extent of your recovery or fails to recognise that you have resumed normal daily routines, such as work, household tasks, or social activities. SIRA is the NSW government body responsible for overseeing motor accident compensation and ensuring insurers act fairly and in accordance with the Motor Accident Injuries Act 2017 (MAIA).
Legal Framework: What SIRA Can and Cannot Address
SIRA does not assess whether you have actually returned to daily activities. Instead, it investigates whether your insurer has acted fairly, in good faith, and in compliance with the MAIA and the Motor Accident Injuries Regulation 2017. Insurers must not unreasonably delay or deny benefits, including treatment and care, weekly income payments, or damages, based on a failure to acknowledge your return to normal life.
SIRA’s role is to review insurer conduct, not to determine medical or functional recovery. If your insurer refuses to acknowledge your return to daily activities, SIRA may intervene if the refusal is not supported by reasonable evidence, such as a medical report or independent assessment. SIRA will not override a medical opinion, but it will examine whether the insurer’s decision was based on a proper assessment of available evidence.
Practical Steps to Take if Your Insurer Rejects Your Return
If your insurer denies or ignores your return to daily activities, take the following steps to preserve your rights:
- Document your daily activities in writing, including dates, tasks performed, and any limitations you still experience. For example, note that you returned to work part-time, resumed cooking, or resumed driving for short trips.
- Obtain a medical certificate from your treating practitioner confirming your functional recovery and ability to perform daily tasks. This should reference your return to work, household duties, or social participation.
- Gather evidence of your activities, such as bank statements showing resumed work payments, receipts for household purchases, or photos of you participating in family events or work tasks.
- Notify your insurer in writing of your return to daily activities, including copies of your medical certificate and supporting evidence. Keep a record of all correspondence.
- If the insurer continues to refuse to acknowledge your return, you may file a complaint with SIRA.
How to File a Complaint with SIRA
To file a complaint, visit the SIRA website and complete the online complaint form. You must provide details of the insurer, the nature of the dispute, and supporting evidence such as medical reports, correspondence, and records of your daily activities. SIRA will review your complaint and may contact you or the insurer for further information.
SIRA will not automatically accept your claim that you have returned to daily activities. Instead, it will assess whether the insurer’s actions were reasonable and consistent with the law. If SIRA finds the insurer acted unfairly, it may direct the insurer to reconsider your claim, pay outstanding benefits, or take other corrective action.
Time Limits and Procedural Requirements
There is no fixed time limit for filing a complaint with SIRA, but delays may affect the strength of your case. It is best to file as soon as possible after the insurer’s refusal. SIRA may not investigate a complaint if more than 12 months have passed since the insurer’s decision, unless there are exceptional circumstances.
If you are seeking damages or weekly payments, time limits apply under the MAIA. For example, a claim for damages must generally be started within three years of the accident. If you are still receiving treatment or weekly payments, the time limit may be extended.
When to Seek Independent Advice
If your insurer continues to dispute your return to daily activities despite evidence, or if you face difficulties in obtaining a medical certificate, it may be appropriate to seek independent legal advice. A solicitor experienced in motor accident claims can help you understand your rights under the MAIA, assess the strength of your evidence, and assist in preparing a formal complaint to SIRA.
Hypothetical Example: A Claimant’s Experience in Sydney
A 38-year-old office worker in Sydney was involved in a rear-end collision in February 2025. After six months of treatment, she returned to part-time work and resumed household duties. Her insurer, however, refused to acknowledge her return, claiming she was still disabled. She provided her treating doctor’s report, bank statements showing resumed salary payments, and photos of her cooking and driving. She filed a complaint with SIRA, which reviewed the evidence and found the insurer had not acted in good faith. SIRA directed the insurer to reinstate her weekly payments and acknowledge her return to daily life.
Next Steps: Requesting Contact About Your Circumstances
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.