If you're an injured motor vehicle claimant in Ashfield, NSW, and believe your insurer mishandled your treatment or rehabilitation planning under the Compulsory Third Party (CTP) scheme, you may be able to raise a complaint with the State Insurance Regulatory Authority (SIRA). This article explains how to formally challenge an insurer's conduct, what evidence to prepare, and when to seek legal advice.
SIRA's Role in Resolving CTP Disputes
SIRA oversees the NSW CTP scheme governed by the Motor Accident Injuries Act 2017. While insurers manage day-to-day claims, SIRA handles complaints about their conduct, including disputes over treatment planning, rehabilitation goals, or delays in approving therapies. SIRA’s role is to ensure insurers comply with the scheme’s rules, not to determine fault or compensation amounts.
Practical Steps to Lodge a SIRA Complaint
To complain about an insurer’s management of your treatment or rehabilitation planning, follow these steps:
- Document the issue: Keep records of all communication with the insurer, including emails, letters, and phone calls. Note any delays in approving treatments or disagreements about rehabilitation goals.
- Gather medical evidence: Obtain copies of your medical reports, treatment plans, and any correspondence between your healthcare providers and the insurer. This shows how the insurer’s actions may have impacted your recovery.
- Submit a written complaint: Use SIRA’s official complaint form or write a letter detailing the issue. Include dates, names of involved parties, and specific examples of the insurer’s conduct.
- Request a review: SIRA will investigate and may request additional information from the insurer or your medical team. You may need to provide further evidence if the insurer disputes your claims.
Evidence That Matters for SIRA Complaints
SIRA will assess whether the insurer acted unreasonably or failed to follow the CTP scheme’s rules. Key evidence includes:
- Medical records showing the insurer refused or delayed approved treatments.
- Insurer correspondence indicating disagreement with rehabilitation plans.
- Witness statements from healthcare professionals or independent experts.
- Evidence of harm caused by the insurer’s actions, such as prolonged recovery time or worsened symptoms.
Time Limits and Dispute Options
You must lodge a SIRA complaint within 12 months of the incident or when the issue arose. If the insurer disputes your claim, you may need to escalate the matter to the NSW Civil and Administrative Tribunal (NCAT) for a formal review. However, SIRA typically handles complaints about insurer conduct before resorting to legal action.
When to Seek Legal Advice
While SIRA provides a regulatory pathway, complex disputes may require legal assistance. A solicitor can help you:
- Navigate SIRA’s complaint process and appeal decisions.
- Challenge the insurer’s interpretation of the CTP scheme.
- Pursue compensation for delays or harm caused by poor treatment planning.
Example Scenario
Consider a claimant who was denied access to a recommended physiotherapy program, delaying their recovery. The insurer’s refusal to approve the treatment, despite medical evidence, could form the basis of a SIRA complaint. The claimant would need to show the insurer’s decision directly impacted their rehabilitation outcomes.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.