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 believe your NSW CTP insurer mishandled your claim, you can formally complain to the State Insurance Regulatory Authority (SIRA). This article explains common complaint scenarios, how to lodge a complaint, and what evidence to prepare. SIRA oversees CTP insurers and investigates complaints about their conduct.
Common Reasons for CTP Insurer Complaints
Injured people in NSW often complain about CTP insurers for issues like:
- Delayed or denied claims despite meeting eligibility criteria
- Refusal to pay for necessary medical treatment
- Poor communication during the claims process
- Incorrectly applying the 52-week benefit limit
- Failing to acknowledge a threshold injury claim
These issues often arise when insurers misinterpret medical evidence, apply strict benefit rules, or fail to respond to claimant inquiries.
How to Lodge a Complaint with SIRA
To complain about an insurer's handling of your CTP claim:
- Contact SIRA directly via their claims hotline or online form
- Provide detailed evidence of the insurer's conduct, including:
- Copies of correspondence with the insurer
- Medical records showing injury severity
- Evidence of denied claims or delayed payments
- Witness statements if applicable
- Explain the impact of the insurer's actions on your recovery
SIRA will review your complaint and may request additional information from the insurer. They will notify you of their findings.
What SIRA Investigates
SIRA investigates complaints about:
- Whether insurers followed CTP scheme rules
- Whether claims were denied without valid reason
- Whether benefits were calculated correctly
- Whether insurers provided adequate support during recovery
Investigations typically take 30-60 days. SIRA may:
- Resolve the issue through mediation
- Require the insurer to correct their conduct
- Refer complex cases to the NSW Civil and Administrative Tribunal (NCAT)
When to Seek Legal Advice
While SIRA handles complaints about insurer conduct, you should consult a solicitor if:
- Your claim was denied without explanation
- You believe the insurer acted in bad faith
- You need help interpreting medical reports
- You want to pursue a common law damages claim alongside CTP benefits
A lawyer can help you understand whether the insurer's actions breached their duty of care under the Motor Accident Injuries Act 2017.
Example Scenario
A cyclist claims weekly benefits for a soft-tissue injury but is told their claim is denied after 52 weeks. They can complain to SIRA by:
- Showing medical evidence of ongoing recovery
- Proving the injury meets the threshold injury definition
- Demonstrating the insurer incorrectly applied the 52-week limit
SIRA will assess whether the insurer followed the correct process for extending benefits.
Next Steps
CTP claims and disputes depend on the accident date, injury type, and insurer conduct. To request contact about your circumstances, complete the quick, no obligation enquiry form.