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 disputing a CTP insurer decision in Albury NSW, the State Insurance Regulatory Authority (SIRA) provides structured processes to address complaints. This article explains how to escalate disputes, what evidence matters, and when to seek legal help.
How to Escalate a CTP Claim Dispute with SIRA
SIRA offers two main dispute resolution pathways for CTP insurer complaints:
- Internal review: You can request a review of your claim by SIRA’s internal team. This process assesses whether the insurer’s decision aligns with the Motor Accident Injuries Act 2017 and SIRA guidelines.
- Mediation: If the internal review doesn’t resolve the issue, SIRA can refer the matter to a neutral mediator. Mediation is voluntary but often helps resolve disputes without further escalation.
To begin, contact SIRA directly via their website or phone. You’ll need to provide:
- A copy of your claim details and the insurer’s decision
- Medical records confirming your injury
- Evidence of the accident (e.g., police reports, witness statements)
- Any correspondence with the insurer
Time Limits for Resolving CTP Disputes
SIRA typically aims to resolve internal reviews within 28 days of receipt. If mediation is required, the process may take up to 60 days, depending on the complexity. Time limits are strict, so act promptly to avoid missing critical deadlines.
When to Seek Legal Advice
Consider consulting a solicitor if:
- The insurer refuses to provide a written explanation for its decision
- You believe the claim assessment ignores your medical evidence
- You need help drafting a formal complaint to SIRA
A lawyer can also help challenge a decision through the Personal Injury Commission (PIC) if the dispute involves medical assessments or compensation thresholds.
Practical Steps to Gather Evidence
To support your dispute, collect:
- Medical records: Highlight how your injury meets SIRA’s threshold injury criteria (e.g., spinal nerve-root injuries with neurological signs)
- Accident reports: Include details like date, time, location, and vehicle involved
- Witness statements: Statements from people who saw the accident
- Photographs: Of the accident scene, vehicle damage, and your injuries
- Income records: To prove lost wages or care costs
Example Scenario
A cyclist in Albury was denied a weekly income payment after a minor collision. They submitted medical evidence showing a soft-tissue injury meeting the threshold injury definition under the Motor Accident Injuries Act 2017. SIRA reviewed the claim and found the insurer had misapplied the guidelines, leading to a revised decision.
Next Steps
If your dispute with the insurer isn’t resolved through SIRA’s processes, you may need to escalate to the Personal Injury Commission. Always act quickly, as time limits apply. For tailored advice, complete the quick, no obligation enquiry form.