If you're an injured road user in regional NSW and believe an insurer has acted unreasonably during a CTP claim, you can raise a complaint with the State Insurance Regulatory Authority (SIRA). This article explains the early steps to lodge a complaint, how SIRA handles insurer conduct, and what evidence is needed to support your case.
What to Do First After an Accident
When you're injured in a motor vehicle accident, the first priority is securing medical attention and documenting the incident. Under NSW CTP rules, insurers must respond to claims promptly. If you suspect an insurer is delaying payments, refusing to cover treatment, or acting unreasonably, you should contact SIRA as soon as possible. Delays in lodging a complaint may reduce your ability to challenge the insurer's conduct.
How SIRA Handles Complaints About Insurers
SIRA oversees the CTP claims process to ensure insurers comply with the Motor Accident Injuries Act 2017. When you lodge a complaint, SIRA will review the insurer's actions to determine if they breached their obligations. This includes assessing whether the insurer:
- Refused to pay benefits without valid reason
- Delayed processing of claims beyond statutory timeframes
- Misrepresented policy terms or claim requirements
SIRA will typically request documentation from both the insurer and the claimant to investigate. While SIRA does not provide legal representation, it will mediate disputes and issue binding decisions if it finds the insurer acted improperly.
What Evidence Matters for a SIRA Complaint
To support your complaint, you'll need to provide:
- Medical records showing the injury's impact
- Proof of the insurer's refusal to pay (e.g., correspondence)
- Evidence of delays in claim processing (e.g., dates of communication)
- Witness statements or accident reports
For example, if an insurer refuses to cover a treatment recommended by your doctor, you should keep copies of all medical reports and correspondence with the insurer. This evidence helps SIRA assess whether the insurer's actions were reasonable under the CTP scheme.
Time Limits and When to Seek Advice
You must lodge a complaint with SIRA within 60 days of the insurer's last response to your claim. If you're unsure whether the insurer's actions were reasonable, seek advice before this deadline. SIRA will not extend time limits unless there are exceptional circumstances.
Next Steps for Injured Road Users
If you're in regional NSW and facing difficulties with an insurer, contact SIRA directly. While SIRA does not provide legal advice, it can investigate the insurer's conduct and enforce compliance with CTP rules. For complex disputes, consider consulting a solicitor who specializes in CTP claims to ensure your rights are protected.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.