Understanding the SIRA Complaint Process in NSW
If you have been involved in a motor accident in Greater Sydney and believe your insurer has acted unfairly or failed to meet their obligations under the Motor Accident Injuries Act 2017 (MAIA), you may consider making a complaint to the State Insurance Regulatory Authority (SIRA). SIRA is the independent regulator responsible for overseeing the Compulsory Third Party (CTP) insurance scheme in New South Wales. A complaint to SIRA is not a substitute for a claim for compensation, but it can be used to address concerns about insurer conduct, delays in processing claims, or failure to provide required benefits.
The process is available to all persons who have suffered injury in a motor accident, including drivers, passengers, pedestrians, cyclists and motorcyclists. It is not limited to those who have already made a claim. However, the nature of your complaint and the evidence you provide will determine whether SIRA can assist. Common issues include delays in approving treatment, refusal to pay weekly income payments, or failure to provide a reasonable explanation for a decision.
Key Mistakes to Avoid When Complaining to SIRA
Many people who contact SIRA about their insurer make errors that reduce the chance of a successful outcome. These mistakes often stem from misunderstanding the process, incomplete documentation, or unclear communication. The most common errors include:
- Failing to provide clear and detailed evidence of the insurer’s actions or inactions. Simply stating "they didn’t pay me" is not sufficient. You must record dates, times, and details of all correspondence, including emails, letters, and phone calls.
- Delaying the complaint beyond a reasonable timeframe. While there is no strict deadline for making a complaint to SIRA, it is best to act promptly. Delays may make it harder to verify facts, especially if records are not retained.
- Not keeping a copy of all correspondence with the insurer. All communications, including emails and letters, should be retained and filed. SIRA will expect to see a full record of your interactions.
- Submitting a complaint without first attempting to resolve the issue directly with the insurer. SIRA encourages parties to try to resolve disputes informally before escalating to a formal complaint. However, if the insurer has ignored your requests or failed to respond, you are not required to wait indefinitely.
- Providing incomplete or inaccurate information on the complaint form. Ensure all details about the accident, injury, treatment, and insurer contact are correct and consistent with your records.
What Evidence Matters in a SIRA Complaint
SIRA will assess your complaint based on the evidence you provide. The most persuasive evidence includes:
- Medical records showing the nature and extent of your injury, treatment received, and any recommendations for ongoing care.
- A copy of your CTP insurer’s decision letter, if you received one, including any reasons for a refusal or delay.
- A record of all communications with the insurer, including dates, times, and names of staff members spoken to.
- Evidence of income loss, such as payslips, a letter from your employer, or a record of time off work.
- Photographs of the accident scene, vehicle damage, or any visible injury, if available.
If you were injured in Greater Sydney, local factors such as traffic conditions, road design, or weather may be relevant. However, these must be supported by evidence and not merely stated as a belief.
When to Seek Independent Advice
A complaint to SIRA is not a legal claim for damages. It is a regulatory complaint about conduct. If you believe your insurer has breached their obligations under the MAIA, SIRA may investigate and issue a direction to the insurer. However, SIRA does not determine whether you are entitled to compensation or how much you should receive.
If you are seeking financial compensation for injury, loss of income, or future care needs, you must make a claim under the CTP scheme. This may involve applying for treatment and care benefits, weekly income payments, or damages if you meet the threshold for a serious injury.
It is important to distinguish between a complaint about insurer conduct and a claim for compensation. You can make a complaint to SIRA while your claim is still being processed. However, if you are unsure about your rights, the evidence you need, or the best way to proceed, it is advisable to seek independent legal advice before submitting a complaint.
Hypothetical Example: Avoiding Common Pitfalls
Imagine a cyclist in Sydney’s inner west was struck by a car at a traffic light in August 2026. The cyclist sustained a back injury and was unable to work for six weeks. The CTP insurer approved initial treatment but refused to pay weekly income benefits on the grounds that the injury was not severe enough. The cyclist wrote to the insurer in September 2026, but received no response. In October 2026, the cyclist submitted a complaint to SIRA.
The complaint was initially dismissed because the cyclist had not kept copies of the letters sent to the insurer, nor had they recorded the dates of their calls. The complaint was later accepted after the cyclist provided a detailed timeline, scanned copies of all correspondence, and a medical certificate confirming the injury and absence from work.
This example shows how failing to keep records and not providing a clear timeline can delay or prevent a successful complaint. It also demonstrates that SIRA will not accept vague or incomplete submissions.
Next Steps and When to Act
Every claim depends on its own facts. The available options may depend on the facts, evidence and applicable law. To request contact about your circumstances, complete the quick, no obligation enquiry form.