How to File a SIRA Complaint About an Insurer in Greater Sydney
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're dealing with an insurer that's not handling your NSW Compulsory Third Party (CTP) claim properly, you can raise a complaint with the NSW Motor Accident Claims Authority (SIRA). SIRA oversees the application of CTP rules in Greater Sydney and provides a formal process for addressing disputes. This guide explains how to file a complaint, what SIRA considers when reviewing claims, and practical steps to take when dealing with an insurer.
Understanding SIRA's Role in CTP Claims
SIRA administers the Motor Accident Injuries Act 2017 (MAIA) and applies the rules set out in the Motor Accident Injuries Regulation 2017. These rules govern what claims are available, how benefits are calculated, and how insurers must handle disputes. In Greater Sydney, SIRA has specific guidelines for resolving complaints about claim processing, including:
- Statutory benefits: Weekly payments for injuries, treatment and care benefits, and lump sum compensation for permanent impairments.
- Dispute resolution: SIRA provides a formal process for challenging decisions about claim eligibility, benefit amounts, or delays.
- Complaint submission: You can lodge a complaint directly with SIRA if you believe an insurer has acted unreasonably or failed to follow the rules.
Practical Steps for Filing a SIRA Complaint
To file a complaint, you must provide evidence that the insurer has not followed SIRA's rules. Key steps include:
- Gather evidence: Collect documents such as medical reports, correspondence with the insurer, and records of claim processing delays. SIRA requires proof that the insurer has not acted in accordance with the MAIA.
- Lodge the complaint: Submit your complaint to SIRA via their online portal or by post. You can request a written response or ask for a review of the insurer's decision.
- Request a review: If SIRA finds the insurer has breached its obligations, it may order the insurer to reconsider its decision or pay additional compensation.
- Escalate if needed: If SIRA's decision is unsatisfactory, you may need to seek legal advice to explore further options, such as mediation or court action.
What SIRA Considers When Reviewing Claims
SIRA evaluates complaints based on whether the insurer has followed the rules outlined in the MAIA and SIRA's guidelines. For example:
- Threshold injuries: SIRA applies the Motor Accident Guidelines to determine if an injury meets the threshold for statutory benefits. If an insurer denies a claim for a threshold injury, SIRA will review whether the medical evidence supports the decision.
- Weekly payments: SIRA ensures insurers pay weekly benefits for injuries that meet the threshold, even if the claimant is not receiving income. This includes cases where the injury affects daily activities or mobility.
- Dispute resolution: SIRA may require insurers to provide a written explanation for denying a claim and to justify any reduction in benefits. If the insurer fails to respond appropriately, SIRA can intervene.
Time Limits and When to Seek Advice
You must lodge a complaint with SIRA within 12 months of the accident date, unless there are exceptional circumstances. If the insurer has already processed your claim and you're unhappy with the outcome, you should act quickly to ensure your complaint is reviewed before the deadline.
If you're unsure whether SIRA's rules apply to your case, or if the insurer is not responding to your concerns, it's advisable to seek legal advice. A solicitor can help you understand your options and ensure your complaint is submitted correctly.
Next Steps
CTP claims in Greater Sydney are governed by strict rules, and disputes with insurers must be resolved through SIRA's formal process. By understanding the steps to file a complaint and the evidence required, you can protect your rights under the MAIA. If you need help with your specific circumstances, complete the quick, no obligation enquiry form to request contact about your claim.