If you believe an insurer has mishandled your treatment or rehabilitation planning under NSW CTP rules, you can raise a complaint with SIRA. This article explains the process, evidence needed, and time limits for challenging insurer decisions in Auburn. SIRA oversees compliance with the Motor Accident Injuries Act 2017, so understanding their requirements is key to a successful complaint.
What Evidence Supports a SIRA Complaint About Treatment Planning?
To challenge an insurer's treatment or rehabilitation planning decisions, you must demonstrate that their actions breached SIRA's guidelines. Required evidence includes:
- Medical records showing the insurer refused or delayed approved treatments
- Documentation of the insurer's refusal to fund necessary rehabilitation plans
- Correspondence with the insurer disputing their decisions
- Evidence of the insurer failing to follow SIRA's rehabilitation planning standards
For example, if an insurer denied funding for physiotherapy despite your doctor recommending it as part of your recovery plan, this could form the basis of a complaint. Always keep copies of all communications with the insurer.
How SIRA Evaluates Rehabilitation Planning Disputes in Auburn
SIRA assesses complaints by reviewing whether insurers adhered to the Motor Accident Guidelines. Key factors include:
- Whether the insurer's treatment plan aligns with the injured person's medical needs
- Whether the insurer followed the 52-week statutory benefit rules for threshold injuries
- Whether the insurer's rehabilitation planning meets SIRA's standards for 'reasonable and necessary' care
SIRA may request additional information, such as medical opinions or expert assessments, to evaluate the dispute. It's important to submit all relevant evidence promptly to support your case.
Time Limits for Complaining About Insurer Treatment Decisions
You have 28 days from the date of a specific insurer decision to raise a complaint with SIRA. For example, if an insurer refuses to fund a recommended treatment on 1 January 2026, you must submit your complaint by 29 January 2026. Missing this deadline may prevent you from challenging the decision through SIRA.
When to Seek Legal Advice
While SIRA provides a formal complaints process, complex disputes may require legal assistance. A solicitor can help you:
- Navigate SIRA's complaint submission process
- Challenge an insurer's refusal to fund necessary treatments
- Pursue a claim for damages if the insurer's actions caused additional harm
If you're unsure whether your complaint meets SIRA's requirements, seek legal advice before submitting your case. Legal professionals can also help you understand whether your insurer's actions may have breached the Motor Accident Injuries Act 2017.
Next Steps for Injured Road Users in Auburn
If you believe an insurer has failed to provide appropriate treatment or rehabilitation planning, start by submitting a written complaint to SIRA within 28 days. Include all relevant evidence to support your case. If SIRA's response is unsatisfactory, you may need to seek legal advice to explore further options.
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