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 experiencing issues with your CTP insurer in NSW, the State Insurance Regulatory Authority (SIRA) provides a formal process to address concerns. This article explains how to file a complaint with SIRA, common reasons for disputes, and practical examples from Ashfield. Understanding your options under NSW CTP law is critical to protecting your claim.
How SIRA Resolves CTP Insurance Disputes
SIRA oversees the Motor Accident Injuries Act 2017, which governs CTP claims. If your insurer refuses to pay benefits, delays processing your claim, or disputes your injury assessment, you can escalate the issue to SIRA. The regulator investigates complaints and ensures insurers comply with legal obligations.
Practical Steps for Filing a SIRA Complaint
To lodge a complaint, gather evidence such as:
- Medical records confirming your injury
- Correspondence with your insurer
- Accident reports or witness statements
- Evidence of delays or refusal to pay
SIRA requires a clear explanation of how the insurer's actions breached the CTP scheme rules. For example, if your insurer denied a claim for soft-tissue injuries without medical evidence, this could form the basis of a complaint.
Common Reasons for SIRA Complaints
Ashfield residents have reported complaints about:
- Insurers refusing to pay weekly benefits after 52 weeks
- Delays in processing claims beyond the 52-week statutory limit
- Refusal to cover treatment costs despite medical evidence
- Incorrectly assessing injury severity
These issues often arise when insurers fail to follow the Motor Accident Guidelines or misinterpret the threshold injury rules.
Time Limits and Dispute Resolution
You must file a complaint with SIRA within 52 weeks of your accident if you're disputing weekly benefits. For other issues, there's no strict time limit, but delays may weaken your case. SIRA typically resolves complaints within 28 days, though complex cases may take longer.
When to Seek Legal Advice
If your insurer disputes your claim's validity or refuses to comply with SIRA's decision, consider consulting a solicitor. Legal advice can help you navigate disputes over weekly benefits, treatment coverage, or lifetime care arrangements.
Example from Ashfield
In one case, a cyclist in Ashfield claimed weekly benefits after a 2023 accident. The insurer denied payments after 52 weeks, arguing the injuries were 'threshold' under the Motor Accident Injuries Act 2017. The claimant escalated the issue to SIRA, which ruled the insurer had failed to properly assess the injury's severity.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.