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 in Bankstown and have a dispute with an NSW CTP insurer over a motor accident claim, SIRA provides structured options to resolve the issue. This article explains how to file a complaint, how SIRA handles disputes, and what resolution pathways exist under NSW law.
How to File a Complaint Against an NSW CTP Insurer
Under the Motor Accident Injuries Act 2017, claimants can raise concerns about an insurer’s decision through SIRA. The process begins by submitting a written complaint to the insurer, outlining the issue and requesting a review. If the insurer’s response is unsatisfactory, you can escalate the matter to SIRA. The insurer must respond within 21 days of receiving the complaint, though this timeline may vary depending on the complexity of the case.
SIRA’s Role in Resolving Disputes
SIRA oversees the CTP claims process and has a formal complaints procedure. When a dispute arises, SIRA will review the insurer’s decision and may request additional evidence, such as medical records or accident reports. If the insurer’s decision is found to be unreasonable, SIRA can direct the insurer to reconsider the claim. However, SIRA does not make decisions on claims itself, it acts as a mediator between claimants and insurers.
Dispute Resolution Options in Bankstown
- Internal Review by the Insurer: The insurer must first review its own decision before the complaint is escalated. This includes assessing whether the claimant’s evidence supports a different outcome.
- SIRA Mediation: If the insurer’s review is unsatisfactory, SIRA may offer mediation to resolve the dispute without formal legal action. This process involves a neutral third party facilitating discussion between the claimant and insurer.
- Formal Complaint to SIRA: If mediation fails, a formal complaint can be submitted to SIRA. The insurer must respond within 21 days, and SIRA will issue a written decision within 14 days of receiving the complaint.
- Legal Action: As a last resort, claimants may pursue legal action through the NSW Civil and Administrative Tribunal (NCAT) or the District Court. This is typically reserved for cases where the insurer’s conduct is alleged to be in breach of the CTP scheme’s rules.
Legal Boundaries of Complaining About an Insurer
When raising a complaint, claimants must ensure their concerns are based on the insurer’s decision-making process, not the merits of the claim itself. For example, complaints may focus on delays, refusal to consider new evidence, or failure to comply with SIRA’s guidelines. Claimants cannot dispute the factual basis of the claim unless the insurer’s interpretation of the law or evidence is unreasonable.
Practical Steps and Evidence That Usually Matter
To support a complaint, claimants should gather:
- Medical records showing the injury’s impact
- Accident reports and witness statements
- Correspondence with the insurer
- Evidence of the insurer’s refusal to reconsider the claim
For instance, if an insurer denies a claim based on a threshold injury assessment, the claimant must demonstrate that the insurer’s interpretation of the guidelines is inconsistent with SIRA’s published criteria. Medical evidence from a registered medical practitioner is critical in such cases.
Time Limits and When to Seek Advice
While there is no strict time limit for filing a complaint, delays may reduce the likelihood of a satisfactory resolution. SIRA recommends addressing disputes promptly, as insurers are more likely to respond positively to complaints raised within the first 21 days of a decision. If the claimant is unsure about their options, seeking advice from a solicitor or legal aid service in Bankstown can help clarify the best course of action.
Example of a Common Dispute
Consider a scenario where a claimant in Bankstown is denied a weekly income payment because the insurer disputes the severity of the injury. The claimant may argue that the insurer’s assessment of the injury’s impact is inconsistent with the medical evidence. SIRA would review whether the insurer followed its guidelines for assessing weekly payments and whether the claimant’s evidence was properly considered.
Next Steps
If you’re in Bankstown and have a dispute with an NSW CTP insurer, the available options depend on the nature of the complaint and the insurer’s response. While SIRA provides structured pathways to resolve disputes, complex cases may require legal assistance. Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.