Where a person's only injuries resulting from the accident are threshold injuries, weekly benefits and treatment and care generally cease after 52 weeks (ss 3.11 and 3.28).
If you're an injured road user in the Illawarra or South Coast regions of New South Wales and believe your insurer has mishandled your Compulsory Third Party (CTP) claim, you may need to lodge a complaint with the State Insurance Regulatory Authority (SIRA). This article explains the early steps to take, the evidence required, and how SIRA handles complaints in regional NSW.
What to Do If Your CTP Claim Is Mismanaged
Under the Motor Accident Injuries Act 2017, insurers must handle CTP claims fairly. If your insurer delays payments, refuses to cover treatment, or disputes your injury, you can raise concerns with SIRA. Start by reviewing your claim details and gathering evidence of the insurer's failure. For example, if your claim was denied without a valid reason, this could form the basis of your complaint.
How SIRA Handles Regional Complaints
SIRA oversees all CTP insurers in NSW, including those in the Illawarra and South Coast. While the process is the same across the state, regional claimants may face additional challenges, such as longer travel times to SIRA offices or limited local support. SIRA’s website provides a complaints form that can be submitted online or by mail. You’ll need to include your claim reference number, details of the insurer’s actions, and any supporting documents.
Evidence to Support Your SIRA Complaint
To strengthen your case, collect the following:
- Medical records showing your injury and treatment
- Copies of correspondence with the insurer
- Witness statements or photos of the accident
- Proof of financial impact (e.g., lost wages)
SIRA will assess whether the insurer’s actions breached its obligations under the CTP scheme. If your complaint is upheld, the insurer may be required to pay additional compensation or rectify its handling of your claim.
Time Limits and When to Seek Advice
You have 52 weeks from the date of your accident to claim statutory benefits under the CTP scheme. However, if your injury is classified as a 'threshold injury' (e.g., soft tissue damage), you may still have a claim beyond this period if your injury meets the spinal nerve-root criteria outlined in the Motor Accident Guidelines. If your insurer refuses to pay, act quickly: SIRA typically takes 4-6 weeks to investigate complaints, but delays can occur.
A Hypothetical Example
Imagine you were in a car accident on the South Coast and your insurer refused to cover your physiotherapy treatment. You could lodge a SIRA complaint by:
- Gathering your medical records and treatment invoices
- Writing to the insurer requesting a written explanation
- Submitting your complaint to SIRA within 52 weeks of the accident
SIRA would then review your case and determine whether the insurer acted unreasonably.
Next Steps
If your insurer’s conduct has caused financial or emotional harm, you may need to seek legal advice to explore further options. While SIRA handles complaints about insurer conduct, it does not provide legal representation. Always keep copies of all documents and consider contacting a solicitor if your claim is denied or disputed.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.