If you believe an insurer has failed to provide adequate treatment or rehabilitation planning for your NSW Compulsory Third Party (CTP) claim, you can raise a complaint with the State Insurance Regulatory Authority (SIRA). This article explains the process for lodging a complaint, the legal standards insurers must meet, and practical steps to support your case.
SIRA's Role in Overseeing Treatment Planning
SIRA is the NSW regulator for motor accident claims and ensures insurers comply with legal obligations. Under the Motor Accident Injuries Act 2017, insurers must develop treatment and rehabilitation plans that align with the Motor Accident Guidelines. These plans must address the injured person’s medical needs, recovery goals, and functional outcomes. If you believe an insurer’s plan is inadequate, SIRA can investigate and enforce compliance.
Practical Steps to Lodge a SIRA Complaint
To file a complaint, you must provide evidence that the insurer’s actions fall below acceptable standards. Key documents include:
- Your treatment and rehabilitation plan from the insurer
- Medical records showing the plan does not meet clinical guidelines
- Correspondence with the insurer about the plan’s adequacy
- Witness statements or expert opinions supporting your case
SIRA’s complaint form is available on its website, and you can submit it online or by mail. You must include specific details about the insurer’s breach of duty, such as failure to update the plan or disregard for medical advice.
Time Limits and Dispute Options
SIRA typically investigates complaints within 30 days. If your complaint is denied, you may request a review or seek independent legal advice. Note that SIRA does not handle disputes over claim value or fault; its role is limited to enforcing compliance with treatment planning standards.
When to Seek Legal Advice
Complex cases, such as disputes over the adequacy of a rehabilitation plan or claims of systemic insurer failures, may require legal assistance. A solicitor can help you interpret SIRA’s guidelines, prepare evidence, and challenge decisions that fail to address your concerns.
Example Scenario
Consider a claimant with a soft tissue injury who receives a treatment plan from an insurer that does not include physiotherapy or occupational therapy. If the plan ignores clinical guidelines requiring these interventions, this could constitute a breach of SIRA’s standards. Documenting the discrepancy between the plan and medical advice strengthens a complaint.
Next Steps
CTP claims involving treatment planning disputes depend on the accident date, injury type, and insurer conduct. To request contact about your circumstances, complete the quick, no obligation enquiry form.