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).
SIRA evaluates liability in CTP claims by assessing fault, contributory fault, and the nature of injuries. In the Newcastle and Hunter regions, insurers must determine whether the accident meets the threshold injury criteria under the Motor Accident Injuries Act 2017. This article explains how SIRA processes liability disputes, what evidence matters, and steps to challenge an insurer's assessment.
Factors SIRA Considers in Liability Assessments
SIRA assesses liability by examining the circumstances of the accident, fault, and contributory fault. Insurers must determine whether the driver or vehicle at fault caused the incident. For example, if a pedestrian was hit at a red light, SIRA would evaluate whether the driver or pedestrian breached road rules. Key factors include:
- Police reports detailing the accident scene and fault
- Witness statements
- CCTV footage
- Medical evidence confirming injuries
- Driver’s license and vehicle registration details
Insurers also check if the injury meets the 'threshold injury' definition in the Motor Accident Guidelines. This includes soft tissue injuries like whiplash, provided they meet specific neurological criteria. SIRA may require medical practitioners to confirm injuries align with the guidelines.
Challenging an Insurer's Liability Assessment
If you believe an insurer incorrectly assessed liability, you can dispute the decision through SIRA. Steps include:
- Requesting a review of the insurer's decision in writing
- Providing additional evidence, such as a second medical opinion or new witness statements
- Submitting a formal complaint to SIRA within 28 days of the insurer's decision
SIRA may refer the matter to a dispute resolution officer or schedule a mediation. In complex cases, SIRA may involve a legal review to determine if the insurer's assessment was lawful.
Resolving Complaints About Liability Evaluations
Disputes over liability assessments often arise when insurers fail to consider all evidence or misinterpret the injury's severity. In Newcastle and Hunter, claimants should:
- Gather all accident-related documents, including police reports and medical records
- Document communication with the insurer, including dates and responses
- Seek advice from a solicitor specialising in CTP claims if the dispute escalates
SIRA typically resolves complaints within 28 days, though complex cases may take longer. If an insurer refuses to pay benefits or disputes liability, claimants may need to escalate the matter to the NSW Civil and Administrative Tribunal (NCAT) for further review.
Practical Example: A Claimant's Experience
A cyclist in Newcastle was involved in a collision with a car. The insurer initially denied liability, claiming the cyclist was at fault for not using a bike lane. The claimant submitted police reports showing the car ran a red light and obtained a medical report confirming soft tissue injuries. SIRA reviewed the evidence, found the insurer's assessment was incorrect, and ordered the insurer to pay benefits. This example highlights how thorough documentation and evidence can resolve disputes.
Next Steps for Claimants
Time limits and procedural requirements vary depending on the accident date and claim type. For instance, claims under the 52-week consequences rule may see limited benefits after 52 weeks if injuries are threshold injuries. To ensure your claim is processed correctly, complete the quick, no obligation enquiry form to discuss your circumstances with a legal professional.