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).
If you believe an insurer has mishandled your Compulsory Third Party (CTP) claim in New South Wales, you can raise a complaint with the State Insurance Regulatory Authority (SIRA). SIRA oversees the application of the Motor Accident Injuries Act 2017 and ensures insurers comply with their obligations. This article explains how to file a complaint, what evidence to gather, and how SIRA resolves disputes.
What SIRA Regulates in CTP Claims
SIRA administers the rules for CTP claims under the Motor Accident Injuries Act 2017. This includes determining eligibility for benefits like weekly income payments, treatment and care benefits, and compensation for injuries. Insurers must follow SIRA’s guidelines when assessing claims, and claimants can challenge decisions by lodging a formal complaint.
How to File a SIRA Complaint
To complain about an insurer’s CTP claim decision, you must first contact the insurer directly to request a review. If the issue isn’t resolved, you can submit a written complaint to SIRA. The complaint should include:
- A clear description of the problem (e.g., denied benefits, incorrect calculation)
- Supporting evidence such as medical records, accident reports, and correspondence with the insurer
- Details of the claimant’s circumstances, including dates of injury and treatment
SIRA will investigate the complaint and provide a written response outlining its decision. You can request a copy of the complaint and any supporting documents from SIRA.
Evidence Needed for a SIRA Complaint
SIRA requires claimants to provide evidence that supports their complaint. This includes:
- Medical records confirming the injury and its impact
- Police reports or witness statements if the accident involved a collision
- Copies of all correspondence with the insurer
- Evidence of financial loss, such as payslips or bank statements
For example, if an insurer refuses to pay weekly income benefits, the claimant must show they meet the threshold injury criteria under the Motor Accident Guidelines. SIRA will assess whether the insurer’s decision aligns with the Act.
Time Limits for SIRA Complaints
SIRA has specific time limits for resolving complaints. Generally, you must lodge a complaint within 60 days of the insurer’s decision. However, this period may extend if the claimant provides additional evidence or requests an extension. It’s crucial to act promptly to avoid missing deadlines.
Disputing a CTP Claim Decision
If SIRA’s decision is unsatisfactory, claimants can escalate the matter to the NSW Civil and Administrative Tribunal (NCAT) for a formal review. NCAT can order the insurer to reconsider its decision or provide compensation for errors. This process is distinct from SIRA’s regulatory oversight and requires a separate application.
When to Seek Legal Advice
While SIRA provides a regulatory pathway for complaints, complex disputes may require legal assistance. A solicitor can help draft formal submissions, challenge insurer decisions, or negotiate a settlement. Legal advice is particularly useful if the claim involves disputes over long-term benefits, lifetime care needs, or overlapping workers’ compensation claims.
Next Steps for Claimants
If you’re unsure whether your complaint meets SIRA’s criteria, or if you need help gathering evidence, contact SIRA directly for guidance. Remember, every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.