Where a person's only injuries resulting from the accident are threshold injuries, weekly benefits and treatment and care generally cease after 52 weeks (ss 3.11 and 3.28).
If you're in Illawarra or the South Coast and believe an insurer mishandled your NSW CTP claim, you can raise a complaint with the State Insurance Regulatory Authority (SIRA). This article explains how to file a complaint, what evidence matters, and how regional claimants may differ from metropolitan areas.
How to File a SIRA Complaint About an Insurer
SIRA oversees the NSW Compulsory Third Party (CTP) scheme, which requires insurers to handle claims fairly. To complain:
- Contact SIRA directly via their website or phone. Regional offices in Wollongong and Nowra may offer local support.
- Submit a written complaint detailing the insurer's actions, such as delays, refusal to pay, or incorrect assessments.
- Include supporting evidence, like correspondence with the insurer, medical reports, and accident details.
SIRA typically responds within 28 days and may request additional information. Regional claimants should note that SIRA's Illawarra and South Coast offices may have different processing times compared to Sydney.
Evidence That Matters for a Successful SIRA Complaint
To strengthen your complaint, gather:
- Medical records showing your injury's connection to the accident.
- Accident reports from police or witnesses.
- Insurer correspondence (emails, letters) documenting delays or disputes.
- Witness statements from people who saw the accident.
- Proof of income if you're claiming lost wages.
For example, a claimant in Moss Vale who alleged an insurer refused to pay for soft tissue injuries needed medical documentation proving the injury met the threshold under the Motor Accident Guidelines. SIRA accepted the complaint after the insurer failed to respond to the evidence.
Regional Differences in Illawarra and South Coast Claims
While SIRA applies NSW law uniformly, regional claimants may face:
- Longer wait times for responses due to office locations.
- Communication challenges if insurers don't have local representatives.
- Unique local factors like rural road conditions affecting accident claims.
Unlike metropolitan areas, some South Coast claimants have reported delays in accessing SIRA's online complaint portal. In one case, a claimant in Kiama had to request a paper form due to technical issues with the digital system.
Time Limits and When to Seek Advice
You have 12 months from the accident date to file a CTP claim with SIRA. For complaints, there's no strict time limit, but delays may weaken your case. If an insurer refuses to pay benefits after 52 weeks, you may need to:
- Request a review of your claim's assessment.
- Seek legal advice if the insurer ignores SIRA's instructions.
- Appeal to the NSW Civil and Administrative Tribunal (NCAT) if necessary.
If you're unsure whether your insurer acted unfairly, contact SIRA's regional office. For complex cases, a solicitor can help navigate the process.
Next Steps
CTP claims and insurer disputes depend on the accident date, injury type, and claim history. To request contact about your circumstances, complete the quick, no obligation enquiry form.