If you're involved in a NSW motor accident claim and believe an insurer is mishandling medical assessments, you may be able to raise a complaint with the State Insurance Regulatory Authority (SIRA). This article explains the process for lodging a complaint with SIRA about an insurer’s conduct during medical assessment preparation, based on NSW Compulsory Third Party (CTP) laws.
What is a SIRA Complaint About Medical Assessments?
SIRA oversees insurers under the Motor Accident Injuries Act 2017. If an insurer fails to follow its guidelines during medical assessment preparation, such as refusing to provide necessary records or delaying assessments, you may have grounds for a complaint. SIRA’s role is to ensure insurers act fairly and in accordance with the law.
Practical Steps to Lodge a SIRA Complaint
To raise a complaint, you’ll need to:
- Document the insurer’s actions: Keep records of all communications with the insurer, including emails, letters, and phone calls.
- Gather evidence: Collect medical records, assessment reports, and any evidence showing the insurer’s conduct deviates from SIRA guidelines.
- Submit a written complaint: Use SIRA’s official complaint form, available on its website, and clearly outline the issue with supporting evidence.
SIRA typically responds within 20 business days and may request further information or mediate the dispute.
Evidence That Matters in a SIRA Complaint
SIRA evaluates complaints based on whether insurers comply with their obligations under the Motor Accident Injuries Act 2017. Key evidence includes:
- Insurer’s failure to provide medical records required for assessments.
- Delays in scheduling assessments without valid reasons.
- Refusal to engage with medical professionals or provide necessary resources.
- Communication that undermines the claimant’s ability to access care.
Time Limits and Dispute Resolution
You must lodge a complaint with SIRA within 12 months of the incident or when you became aware of the insurer’s misconduct. If the insurer disputes the complaint, SIRA may refer the matter to a dispute resolution process or mediation.
When to Seek Legal Advice
While SIRA handles complaints about insurer conduct, complex cases may require legal assistance. A solicitor can help if:
- The insurer refuses to cooperate with SIRA.
- You believe your claim is being unfairly limited by the insurer’s actions.
- You need to challenge a decision made by SIRA.
Example Scenario
Consider a claimant in Ballina who was involved in a car accident and required ongoing medical treatment. The insurer refused to provide medical records needed for a scheduled assessment, delaying the claimant’s access to necessary care. This could form the basis of a SIRA complaint, as the insurer’s actions may breach its duty to cooperate with claimants.
Next Steps
CTP claims and disputes often depend on the specific facts of the case. If you’re unsure whether your situation meets SIRA’s criteria for a complaint, or if you need help preparing your evidence, complete the quick, no obligation enquiry form to request contact about your circumstances.