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).
SIRA (State Insurance Regulatory Authority) oversees complaints about NSW CTP insurers, including how they assess liability. If you believe an insurer has misinterpreted your claim, you can lodge a complaint with SIRA. This article explains the process, how insurers evaluate liability in the Newcastle and Hunter regions, and what evidence matters. It also covers time limits and when to seek legal advice.
SIRA's Role in Resolving Complaints
SIRA ensures insurers comply with the Motor Accident Injuries Act 2017 and its regulations. To complain, you must first attempt to resolve the issue directly with the insurer. If unresolved, submit a written complaint to SIRA within 12 months of the accident date. SIRA will review your case, request evidence from the insurer, and issue a decision. While SIRA does not provide legal advice, its rulings are binding on insurers.
How NSW CTP Insurers Assess Liability
Insurers assess liability based on the accident's circumstances, not fault. Under the Motor Accident Injuries Act 2017, liability arises if the accident involves a motor vehicle, regardless of who was at fault. Insurers evaluate claims by:
- Reviewing police reports, witness statements, and accident scene photos
- Assessing medical evidence to determine if injuries meet the 'threshold injury' definition
- Checking if the injury resulted from the accident (not a pre-existing condition)
- Applying the 52-week statutory benefit rules for injuries that don't meet the whole person impairment threshold
In the Newcastle and Hunter regions, insurers may consider local factors like road conditions or traffic patterns, but these must be directly relevant to the accident. SIRA will investigate claims of biased assessments.
Evidence to Support a SIRA Complaint
To strengthen your complaint, gather:
- A copy of the insurer's liability assessment letter
- Medical records showing the injury's connection to the accident
- Police reports or accident statements
- Witness contact details
- Photos of the accident scene
- Communication with the insurer (emails, letters)
If the insurer denied a claim without explanation, this could indicate a procedural error. SIRA requires insurers to provide written reasons for decisions.
Time Limits and Dispute Options
You must lodge a complaint with SIRA within 12 months of the accident. If SIRA's decision is unsatisfactory, you can:
- Request a review of the decision
- Seek mediation through the NSW Civil and Administrative Tribunal (NCAT)
- Lodge a formal complaint with the NSW Ombudsman
Note that SIRA does not handle disputes over the amount of compensation. For complex claims, legal advice may be necessary to challenge an insurer's interpretation of the law.
When to Seek Legal Advice
Consult a lawyer if:
- The insurer refuses to provide written reasons for its decision
- You believe the insurer has misapplied the threshold injury rules
- You need help challenging a liability assessment
- You're unsure if your claim meets the criteria for statutory benefits
A solicitor can help you understand your rights under the Motor Accident Injuries Act 2017 and ensure SIRA processes your complaint correctly.
Conclusion
SIRA plays a critical role in ensuring insurers fairly assess liability under NSW CTP rules. While the process is consistent across the state, regional factors like Newcastle's traffic density or Hunter's rural roads may influence specific cases. If you're unsure how an insurer assessed your claim, complete the quick, no obligation enquiry form to request contact about your circumstances.