How NSW Insurers Assess Liability in CTP Claims
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).
NSW insurers evaluate liability in Compulsory Third Party (CTP) claims by assessing fault, injury severity, and compliance with the Motor Accident Injuries Act 2017 (MAIA). SIRA (Safety Insurance Regulatory Authority) oversees this process to ensure insurers apply the law consistently. If you dispute an insurer’s liability assessment, understanding their evaluation criteria and SIRA’s regulatory role is critical.
Key Factors in Liability Assessments
Insurers consider several factors when determining liability:
- Fault: Whether the accident involved a motor vehicle and if the driver or owner owed a duty of care.
- Contributory fault: If the claimant contributed to the accident, it may reduce compensation.
- Threshold injury: Injuries meeting the MAIA’s definition (e.g., soft tissue injuries with neurological signs) qualify for statutory benefits.
- Evidence: Police reports, medical records, and witness statements help establish fault and injury.
SIRA’s guidelines clarify that insurers must apply the MAIA’s rules uniformly. For example, if an accident involves a car park or private property, the legal character of the location and vehicle use must be assessed.
SIRA’s Role in Regulating Liability
SIRA ensures insurers comply with the MAIA and its regulations. If an insurer denies a claim without valid reasons, SIRA can investigate. Claimants can raise concerns through SIRA’s complaint process, which includes:
- Submitting evidence of the accident and injuries.
- Requesting a review of the insurer’s decision.
- Seeking mediation or formal dispute resolution.
SIRA’s website provides resources for disputing liability assessments, including templates for formal complaints.
Practical Steps for Claimants
If you dispute an insurer’s liability assessment, take these steps:
- Gather evidence: Collect medical records, accident reports, and witness details.
- Review the insurer’s decision: Ensure it aligns with the MAIA’s rules on fault and injury.
- Contact SIRA: Use SIRA’s complaint process to challenge the assessment.
- Seek independent advice: A legal professional can help navigate disputes and time limits.
Time Limits and Dispute Options
CTP claims must be submitted within 6 months of the accident under the MAIA. If an insurer refuses to pay benefits after 52 weeks, claimants may need to reapply for statutory payments. Disputes over liability can be resolved through SIRA’s mediation or by applying to the NSW Civil and Administrative Tribunal (NCAT).
Example: Disputing a Liability Assessment
Consider a pedestrian hit by a car where the insurer claims the claimant was at fault. SIRA would assess whether the pedestrian’s actions (e.g., crossing against a light) contributed to the accident. If the insurer fails to apply the MAIA’s contributory fault rules, SIRA may intervene.
When to Seek Legal Advice
If an insurer’s liability assessment appears unfair or inconsistent with SIRA guidelines, consult a legal professional. They can help you understand your rights under the MAIA and ensure your claim meets all legal requirements.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.