If you're an injured road user in Ashfield, NSW, and have issues with your CTP insurer, you have legal rights to escalate the matter. Under NSW law, injured drivers, passengers, cyclists, or pedestrians can raise complaints about insurer conduct through the State Insurance Regulatory Authority (SIRA). This guide explains the early steps to take, what evidence matters, and how SIRA handles complaints about CTP insurers.
What to Do First: Contact the Insurer
Before escalating to SIRA, injured road users must first attempt to resolve the issue directly with the insurer. This includes:
- Writing a formal complaint letter detailing the problem (e.g., delayed payments, refusal to cover treatment)
- Requesting a written response within 14 days of submitting the complaint
- Keeping copies of all correspondence
If the insurer fails to respond or resolve the issue within this timeframe, you may need to escalate the matter. SIRA requires complaints to be made within 14 days of the insurer's last response, though extensions may be granted for complex cases.
When to Contact SIRA
SIRA handles complaints about CTP insurers under the Motor Accident Injuries Act 2017. You can lodge a complaint if:
- The insurer has not paid a claim within 14 days of being notified
- The insurer has refused to cover a legitimate claim
- The insurer has acted unreasonably or unethically
To complain, you'll need to provide:
- Your claim number and details of the incident
- Evidence of the insurer's failure to act (e.g., emails, letters)
- Medical records showing the injury's impact
- Proof of income loss or treatment costs
SIRA will investigate and may require the insurer to provide a written explanation. If the insurer fails to comply, SIRA can issue a formal notice or refer the matter to the NSW Civil and Administrative Tribunal (NCAT).
What SIRA Can Do
SIRA has the authority to:
- Order insurers to pay claims they've refused
- Require insurers to provide information about claim progress
- Impose financial penalties on insurers for misconduct
However, SIRA cannot make direct payments to injured road users. If your claim is denied or delayed, you may need to pursue a separate legal claim through the NSW Civil and Administrative Tribunal (NCAT) or the District Court.
Key Evidence to Gather
When complaining about a CTP insurer, you must provide:
- A copy of your claim form and any correspondence with the insurer
- Medical records confirming your injury and treatment
- Evidence of financial loss (e.g., wage slips, receipts for out-of-pocket expenses)
- Witness statements or accident reports
For example, if an insurer refuses to cover a soft tissue injury, you must show that your injury meets the threshold injury definition in the Motor Accident Guidelines. This includes documenting neurological signs or treatment received.
Time Limits and Next Steps
CTP insurers must respond to claims within 14 days of being notified. If they fail to act, you have 14 days from their last response to escalate to SIRA. If SIRA cannot resolve the issue, you may need to:
- Apply to NCAT for an order compelling the insurer to pay
- Pursue a damages claim if the insurer has acted in bad faith
It's important to act quickly, as delays can reduce your ability to claim compensation. If you're unsure about your options, seek advice from a solicitor specialising in NSW CTP claims.
When to Seek Legal Advice
You should consult a lawyer if:
- The insurer has refused to pay a claim
- You've been denied a claim for a threshold injury
- You need to dispute the insurer's assessment of your injury
A solicitor can help you understand your rights under the Motor Accident Injuries Act 2017 and ensure you meet all procedural requirements.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.