Understanding SIRA’s Role in Motor Accident Claims
If you have been injured in a motor accident in New South Wales and believe your insurer has not handled your claim fairly or in accordance with the law, you may be able to lodge a formal complaint with the State Insurance Regulatory Authority (SIRA). This process is available to injured road users across Greater Sydney and other parts of NSW who have experienced issues such as delays in processing claims, failure to provide required benefits, or disputes over entitlements under the Motor Accident Injuries Act 2017 (MAIA).
SIRA is the independent regulator responsible for overseeing the compulsory third party (CTP) insurance scheme in NSW. It ensures that insurers comply with legal obligations and that injured people receive the benefits they are entitled to under the law. A complaint to SIRA is not a substitute for legal advice, but it is a formal step to address concerns about insurer conduct.
Early Steps to Lodge a SIRA Complaint
The first practical step is to ensure you have all relevant documentation to support your complaint. This includes:
- A copy of the accident report (if completed by police or transport authority)
- Medical records and treatment notes from your healthcare provider
- Correspondence with your insurer, including emails, letters, and call records
- Details of any benefits you have been denied or delayed, such as weekly income payments, treatment and care benefits, or damages
- A record of the dates and outcomes of all communications with the insurer
You must notify your insurer in writing of your intention to complain to SIRA. This is a required step before SIRA will accept your complaint. The insurer must then provide a written response, which you should keep as part of your evidence.
SIRA will not accept a complaint if you have not first raised the issue with your insurer and given them a reasonable opportunity to respond. This is a procedural requirement under SIRA’s complaint handling framework.
What Evidence Supports a SIRA Complaint?
SIRA requires clear and factual evidence to assess a complaint. The most common grounds for complaint relate to:
- Failure to pay weekly income payments within 14 days of a claim being accepted
- Unreasonable delay in approving treatment and care benefits
- Denial of benefits without proper justification under MAIA
- Refusal to pay damages without a valid legal basis
You must provide evidence that shows the insurer failed to act within the timeframes required by law. For example, under MAIA, an insurer must make a decision on a claim within 21 days of receiving all necessary information. If they fail to do so, this may be grounds for a complaint.
SIRA may also investigate if an insurer has not followed the Motor Accident Injuries Guidelines, which set out the standards for medical treatment, impairment assessment, and benefit entitlements. For instance, if your insurer refused treatment for a soft tissue injury without a medical review, and you have a referral from a medical practitioner, this may indicate a breach of the insurer’s obligations.
How SIRA Handles Complaints from Injured Road Users
Once a complaint is submitted, SIRA will acknowledge receipt within 10 business days. They will then assess whether the complaint falls within their jurisdiction and whether the insurer has met their legal obligations under MAIA and the Motor Accident Injuries Regulation 2017.
SIRA may contact both you and your insurer to gather further information. They may also review medical reports, claim files, and correspondence to determine whether the insurer’s actions were reasonable and in line with the law.
If SIRA finds that the insurer has failed to comply with their obligations, they can direct the insurer to take corrective action. This may include paying outstanding benefits, reimbursing out-of-pocket expenses, or providing a formal explanation. In some cases, SIRA may issue a formal direction to the insurer to rectify the breach.
SIRA does not determine whether you are entitled to damages or assess impairment for a common law claim. Their role is limited to ensuring that the insurer has met their statutory obligations under the CTP scheme.
Time Limits and Procedural Requirements
There is no fixed time limit for lodging a complaint with SIRA, but it is important to act promptly. Delays may affect the availability of evidence, such as medical records or insurer correspondence, and may impact SIRA’s ability to investigate.
You must not wait for a final decision on your claim before lodging a complaint. If you are in dispute with your insurer over a benefit, you can raise the issue with SIRA at any time during the claim process.
If you have already received a decision from your insurer and believe it is incorrect, you should not wait for a formal review process to begin. You can contact SIRA immediately to raise your concern.
When to Seek Independent Advice
While SIRA provides a formal process for addressing insurer conduct, it does not provide legal representation or advice. If your claim involves complex issues such as threshold injuries, whole person impairment, or a dispute over damages, you may need to consult a legal practitioner who specialises in motor accident injury law.
A common example: A cyclist in Sydney was injured in a collision with a car in a car park. The insurer denied weekly income payments on the grounds that the injury was not serious enough, despite medical evidence of a spinal nerve-root injury with neurological signs. The cyclist submitted a complaint to SIRA, which required the insurer to review the claim and provide a revised decision. The insurer eventually approved the payments after SIRA intervened.
This example illustrates that SIRA can play a practical role in resolving disputes, but it does not replace the need for accurate medical evidence and a clear record of communications.
Next Steps
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.