If you're dealing with an insurer's handling of medical assessments for your NSW Compulsory Third Party (CTP) claim, you may need to raise a complaint with the State Insurance Regulatory Authority (SIRA). This article explains how to formally complain to SIRA about insurer practices, what evidence to gather, and how SIRA addresses concerns about medical assessments in regional areas.
The Legal Framework for SIRA Complaints
SIRA oversees the NSW CTP scheme under the Motor Accident Injuries Act 2017. While SIRA's primary role is to regulate insurers, it also handles complaints about how claims are managed. If an insurer is unreasonably delaying or refusing to prepare for medical assessments, this could breach their obligations under the CTP scheme.
Practical Steps to Complain to SIRA
To lodge a complaint, start by gathering evidence of the insurer's actions. This includes:
- Copies of all correspondence with the insurer
- Medical records showing delays in assessment scheduling
- Witness statements or expert opinions about the insurer's conduct
- Documentation of any financial or emotional impact from the delay
SIRA requires complaints to be submitted in writing. You can use the online form on the SIRA website or contact them directly via phone. Be specific about the insurer's actions and how they've affected your claim.
What SIRA Looks For in Medical Assessment Complaints
SIRA evaluates complaints based on whether the insurer has followed its duty of care. For example, if an insurer refuses to arrange a medical assessment without valid reason, or if it unreasonably extends the timeline for assessments, this could be considered a breach. SIRA may investigate by reviewing documents or speaking with the insurer.
Time Limits and When to Seek Advice
You have 12 months from the date of the accident to lodge a claim with SIRA. If the insurer is not responding to your requests for medical assessments, you should act quickly. Delays in seeking resolution can weaken your case, especially if the insurer claims the claim is 'out of time' or 'no longer valid'.
A Hypothetical Example
Imagine an insurer refuses to schedule a medical assessment for a regional claimant, citing 'logistical challenges'. If the claimant can show the insurer has access to regional medical professionals and the delay is unnecessary, this could form the basis of a SIRA complaint. The insurer may then face penalties for breaching its obligations.
Next Steps
If you're facing delays or issues with your insurer's medical assessment process, it's important to act promptly. While SIRA can address complaints about insurer conduct, complex disputes may require legal advice. Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.