If you're an injured road user in Balmain, NSW, and your CTP insurer is not meeting its obligations, you have legal rights to challenge their conduct. This article explains the early steps to take when lodging a complaint with the NSW Motor Accident Insurance Regulatory Authority (SIRA), including what evidence to prepare and how SIRA handles disputes under the Motor Accident Injuries Act 2017.
What to Do First: Contact Your Insurer in Writing
Before escalating a complaint, injured road users should formally request resolution from their CTP insurer. Under NSW law, insurers must respond to claims within 21 days of receiving all required documentation. If your insurer delays payment, ignores your claim, or disputes liability without justification, you should:
- Write a letter outlining your claim and request a written response
- Keep copies of all correspondence
- Note the insurer’s response date and any refusal reasons
This step is critical because SIRA only intervenes if the insurer fails to resolve the issue within its internal processes. For example, if an insurer refuses to pay for medical treatment without a valid reason, this could constitute a breach of their obligations under the CTP scheme.
How SIRA Handles Complaints About CTP Insurers
SIRA oversees the CTP scheme and has specific powers to investigate insurer conduct. When an injured road user lodges a complaint, SIRA will:
- Review the insurer’s handling of the claim
- Check if the insurer has followed its own internal procedures
- Determine if the insurer has breached its legal duties under the Motor Accident Injuries Act 2017
SIRA’s role is not to make decisions about claim merits but to ensure insurers comply with their obligations. For instance, if an insurer refuses to pay for a legitimate claim without a valid reason, SIRA may issue a formal notice requiring the insurer to rectify the issue.
Evidence Needed for a SIRA Complaint
To support a complaint, injured road users should gather:
- A copy of the accident report
- Medical records showing the injury’s connection to the accident
- Proof of lost income or additional expenses
- Correspondence with the insurer
- Witness statements if available
These documents help SIRA assess whether the insurer has acted in accordance with its legal duties. For example, if an insurer denies a claim for soft tissue injury without referring to the Motor Accident Guidelines, this could be a valid basis for complaint.
Time Limits and When to Seek Advice
There is no strict time limit for lodging a complaint with SIRA, but delays can reduce your ability to challenge an insurer’s decisions. Under NSW law, insurers must respond to claims within 21 days, and SIRA typically investigates complaints within 28 days. If your insurer has not resolved the issue within this timeframe, you should:
- Submit a written complaint to SIRA
- Include all relevant evidence
- Request a written response
It’s also advisable to seek legal advice if your insurer has refused to pay for essential treatments or has disputed liability without justification. A solicitor can help you understand whether your claim meets the threshold injury criteria under the Motor Accident Injuries Act 2017.
A Hypothetical Example
Imagine a Balmain resident who was injured in a car accident and submitted a claim for medical treatment. The insurer refused to pay, claiming the injury was not serious. The injured person followed the steps above, wrote to the insurer, and then lodged a complaint with SIRA. SIRA found the insurer had not followed its own procedures and required the insurer to pay the claim. This example shows how the process works in practice.
Next Steps
CTP entitlements and deadlines can depend on the accident date, injury type, and claim history. To request contact about your circumstances, complete the quick, no obligation enquiry form.