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 facing a complaint with NSW's State Insurance Regulatory Authority (SIRA) about an insurer's handling of a motor accident claim, understanding what evidence insurers must keep is critical. SIRA enforces strict record-keeping rules under the Motor Accident Injuries Act 2017 to ensure transparency and fairness. This article explains the key evidence insurers must retain, how SIRA's guidelines apply to Western Sydney claims, and steps to challenge decisions using official requirements.
What Evidence Must NSW CTP Insurers Retain?
SIRA requires insurers to maintain detailed records to support their decisions. Key evidence includes:
- Medical records documenting injuries, treatments, and recovery progress
- Accident reports from police, witnesses, or scene investigators
- Communication logs with claimants, including correspondence with solicitors
- Financial records showing payments made for treatment, lost income, or other benefits
- Insurer internal reviews of claim decisions, including assessments of injury severity
Insurers must also retain records of any threshold injury assessments under the Motor Accident Guidelines, which determine eligibility for statutory benefits. Failure to keep these records may weaken an insurer's position during SIRA investigations.
How SIRA's Evidentiary Rules Apply in Western Sydney
SIRA applies uniform standards across NSW, including Western Sydney. Insurers must:
- Document all decisions in writing, including reasons for denying or adjusting claims
- Retain records for at least five years under the Motor Accident Injuries Regulation 2017
- Provide claimants with access to relevant documents upon request
When disputing a decision, claimants should verify whether insurers have followed these rules. For example, if an insurer refuses to pay for ongoing treatment, SIRA requires them to show that the treatment is not 'reasonably necessary' under the guidelines.
Practical Steps for Claimants
If you believe an insurer has breached SIRA's record-keeping rules, take these steps:
- Request copies of all relevant documents from the insurer, including internal assessments and correspondence
- Review the Motor Accident Guidelines to check if the insurer's injury assessments align with official thresholds
- Submit a SIRA complaint if you suspect the insurer has failed to keep proper records or acted unfairly
SIRA typically responds to complaints within 28 days and may investigate the insurer's compliance with legal obligations. In complex cases, claimants may need to provide expert medical opinions to challenge an insurer's injury severity assessment.
Time Limits and When to Seek Advice
SIRA requires insurers to resolve disputes within 28 days of receiving a complaint. If an insurer fails to act within this timeframe, claimants may have grounds to escalate the matter. However, time limits for making claims themselves remain unchanged, most CTP claims must be submitted within 12 months of the accident, though exceptions exist for long-term injuries.
If you're unsure whether an insurer has followed SIRA's rules, seek legal advice early. Claims involving disputes over evidence or record-keeping often require specialist input to ensure all legal requirements are met.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.