SIRA Complaint Process for Injured Road Users in NSW
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 an injured road user in New South Wales and believe your insurer has mishandled your Compulsory Third Party (CTP) claim, you have the right to raise concerns with the State Insurance Regulatory Authority (SIRA). This guide explains the formal process for lodging a complaint, the evidence required, and time limits under the NSW CTP scheme.
What Is the CTP Scheme and SIRA's Role?
The CTP scheme provides compensation for injuries caused by motor vehicle accidents. SIRA oversees the scheme, ensuring insurers comply with the Motor Accident Injuries Act 2017 and its regulations. While SIRA does not assess the merits of claims, it handles complaints about insurers' conduct during the claims process.
Practical Steps to Lodge a SIRA Complaint
- Contact SIRA Directly
Reach out to SIRA via their website or phone to discuss your complaint. You can request a complaint form or seek guidance on the process.
- Document the Issue
Gather evidence showing the insurer's failure to act in accordance with CTP rules. This includes:
- Copies of your claim forms and correspondence with the insurer.
- Records of delayed payments or refusal to provide benefits.
- Medical reports confirming your injury and treatment.
- Witness statements or accident reports.
- Complete a Complaint Form
SIRA provides a standard form for complaints. Fill it out clearly, explaining the issue and referencing the relevant sections of the Motor Accident Injuries Act 2017.
Evidence That Matters Most
SIRA evaluates complaints based on whether the insurer acted unreasonably or failed to follow CTP guidelines. Key evidence includes:
- Insurer's Conduct: Prove the insurer ignored your claim, delayed benefits, or refused to pay without valid reason.
- CTP Rules Violation: Show the insurer breached obligations under the Motor Accident Injuries Act 2017, such as failing to provide weekly income payments for threshold injuries.
- Medical Evidence: Confirm your injury meets the threshold injury definition under the Motor Accident Guidelines.
Time Limits for Making a Complaint
You must lodge a complaint with SIRA within 12 months of the accident date. This applies to all CTP-related disputes, including issues with benefit payments, claim assessments, or insurer conduct.
When to Seek Legal Advice
If your complaint is rejected or the insurer disputes your claim, consider consulting a solicitor. A lawyer can help you:
- Challenge SIRA's decision through formal review.
- Pursue a claim for damages if the insurer's conduct caused additional harm.
- Navigate disputes over the interpretation of CTP rules.
Example Scenario
A passenger in a car accident receives a delayed payment for weekly income benefits. The insurer refuses to pay until the passenger provides additional medical evidence. This delay could form the basis of a SIRA complaint, as the insurer failed to act within the CTP scheme's timeframes.
Next Steps
CTP entitlements depend on the accident date, injury type, and insurer conduct. To request contact about your circumstances, complete the quick, no obligation enquiry form.