How SIRA Handles Complaints About Insurer Liability Assessments in Ashfield NSW

How SIRA Handles Complaints About Insurer Liability Assessments in Ashfield NSW

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 Ashfield and disagree with how an insurer assessed liability for your motor accident claim, you may need to raise a complaint with the NSW Motor Accident Claims Authority (SIRA). Insurers assess liability based on fault, evidence, and legal standards under the Motor Accident Injuries Act 2017. This article explains how insurers evaluate liability, how SIRA handles disputes, and steps to take if you believe an assessment was unfair.

Key Factors Insurers Use to Assess Liability

Insurers determine liability by examining:

• Fault: Whether the accident was caused by another driver’s negligence or breach of duty.
• Contributory fault: If you contributed to the accident, it may reduce the insurer’s liability.
• Evidence: Police reports, witness statements, and medical records are critical.
• Legal thresholds: Threshold injuries (e.g., soft tissue injuries) are defined under the Motor Accident Guidelines and may affect benefits.

Insurers must apply these factors consistently, but disputes often arise when claimants believe the assessment was incorrect or incomplete.

How SIRA Guides Liability Disputes

SIRA oversees the CTP claims process and provides guidance on resolving conflicts. If you disagree with an insurer’s liability decision:

• Review SIRA’s guidelines: The What you can claim page explains what benefits are available and how they’re calculated.
• Submit a complaint: SIRA allows complaints about insurer conduct, including liability assessments. You’ll need to provide evidence showing the insurer’s decision was unreasonable.
• Seek mediation: SIRA may refer disputes to mediation before formal action.

SIRA’s role is to ensure insurers comply with the law, but it does not make decisions about liability itself. Claimants must prove the insurer’s assessment was legally flawed.

Practical Steps for Claimants in Ashfield

If you believe an insurer’s liability assessment is incorrect, take these steps:

1. Gather evidence: Collect all documents related to the accident, including medical reports, police statements, and witness details.
2. Check the insurer’s decision: Review the insurer’s written explanation of why they assessed liability a certain way.
3. Contact SIRA: Use SIRA’s Making a motor accident claim page to submit a complaint. Include specific examples of how the assessment may be incorrect.
4. Seek independent advice: A solicitor can help you understand your options and whether a dispute is likely to succeed.

Time Limits and Dispute Options

You have 6 months from the accident date to make a claim under the Motor Accident Injuries Act 2017. If you’ve already submitted a claim, you may still raise a complaint about liability if the insurer’s assessment was made within that timeframe.

Disputes over liability can be complex. For example, if an insurer denies a claim based on a threshold injury assessment, you may need to challenge their interpretation of the Motor Accident Guidelines. SIRA will review such cases based on the evidence provided.

When to Seek Legal Advice

If you’re unsure whether an insurer’s liability assessment was fair, or if you need help preparing a complaint to SIRA, consult a solicitor. Legal advice can help you:

• Understand how contributory fault affects your claim.
• Challenge an insurer’s interpretation of threshold injuries.
• Navigate SIRA’s complaint process effectively.

Example of a Liability Dispute

Consider a scenario where a driver in Ashfield is injured in a collision. The insurer assesses the claim as a threshold injury, limiting benefits to 52 weeks. The claimant may dispute this by showing:

• Medical evidence of ongoing symptoms beyond the 52-week period.
• Evidence that the injury meets the spinal nerve-root criteria under the Motor Accident Guidelines.
• A police report indicating the other driver was at fault.

In such cases, SIRA will review the insurer’s decision and may require further investigation.

Next Steps

CTP claims and liability assessments depend on the specific facts of each case. If you’re in Ashfield and disagree with how an insurer assessed liability, you should:

• Review the evidence carefully.
• Submit a complaint to SIRA.
• Seek legal advice if needed.

Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.