If you're in regional NSW and have a dispute with your CTP insurer, you have options to escalate your complaint through the State Insurance Regulatory Authority (SIRA). This guide explains how to file a complaint, what evidence is needed, and the dispute resolution options available to you.
How to File a Complaint About an Insurer's Handling of a CTP Claim
If your insurer has not acted in accordance with the Motor Accident Injuries Act 2017 or has made a decision you believe is incorrect, you can lodge a complaint with SIRA. The process begins by contacting your insurer to request a review of their decision. If you're not satisfied with their response, you can escalate the matter to SIRA.
To file a complaint with SIRA, you must provide:
- A copy of your claim form and any correspondence with your insurer
- Details of the insurer’s decision and your disagreement with it
- Supporting evidence such as medical records, accident reports, or witness statements
- A clear explanation of why you believe the insurer’s decision was incorrect
SIRA will then review your complaint and may request additional information or arrange a meeting with your insurer to resolve the dispute.
Dispute Resolution Options Through SIRA
SIRA offers several dispute resolution options to help resolve conflicts with insurers. These include:
- Internal review - Your insurer must review its decision and provide a written response within 21 days
- Mediation - A neutral third party helps both parties reach an agreement
- Formal review - SIRA may conduct a full review of the insurer’s decision if the dispute is complex or significant
- Complaint to the Personal Injury Commission - In some cases, you may escalate your complaint to the Personal Injury Commission, which has the authority to review and potentially overturn an insurer’s decision
If your dispute involves a medical assessment or disagreement with a medical report, SIRA may refer your case to a medical expert for further review. This process ensures that your concerns are thoroughly examined before any decision is made.
What Evidence Is Needed to Support a SIRA Complaint
When lodging a complaint with SIRA, it’s important to provide clear and relevant evidence to support your case. This includes:
- Medical records - These should show the nature and extent of your injuries, as well as any treatment received
- Accident reports - These provide details of the incident, including the date, time, location, and any witnesses
- Witness statements - Statements from people who saw the accident or can confirm the circumstances
- Photographs - Photos of the accident scene, vehicle damage, or injuries can be useful evidence
- Correspondence with your insurer - Emails, letters, or other records showing the insurer’s response to your claim
If your insurer has made a decision based on a medical report, you may need to provide additional evidence to challenge that report, such as a second opinion from another medical practitioner.
How SIRA Handles Disputes in Regional NSW
SIRA has a dedicated team to assist people in regional areas, but access to services may be limited. If you live in a regional area, you may need to contact SIRA by phone or email to request assistance. In some cases, SIRA may arrange for a meeting or review to be conducted remotely.
If your dispute involves a complex medical or legal issue, SIRA may refer your case to the Personal Injury Commission for further review. This process ensures that your concerns are thoroughly examined before any decision is made.
When to Seek Legal Advice
If your dispute with your insurer is not resolved through SIRA’s processes, you may need to seek legal advice. A solicitor can help you understand your options, prepare your case, and represent you in any further dispute resolution steps.
It’s important to act quickly, as there are time limits for lodging complaints and escalating disputes. If you’re unsure about your next steps, contact SIRA or a legal professional for guidance.
Next Steps
If you're in regional NSW and have a dispute with your CTP insurer, you have options to escalate your complaint through SIRA. By providing the right evidence and following the correct procedures, you can work towards a resolution that reflects your circumstances.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.