Understanding CTP Treatment Provider Disputes in Regional NSW
If your motor accident treatment has been delayed, limited or denied by your Compulsory Third Party (CTP) insurer, and you are in regional NSW, you may face a dispute over which medical treatment is approved. This can happen when an insurer refuses to fund a treatment recommended by your medical practitioner, or limits the number of sessions. These disputes are common in regional areas, where access to specialists and rehabilitation services is more limited. The Motor Accident Injuries Act 2017 and the Motor Accident Injuries Regulation 2017 set out the legal framework for resolving such disputes. You have rights under this framework to challenge decisions that affect your recovery and access to care.
The Legal Framework for Treatment Disputes
Under the Motor Accident Injuries Act 2017, you are entitled to reasonable and necessary treatment and care for injuries arising from a motor accident. This includes medical treatment, rehabilitation services and allied health support. Insurers must approve treatment that is clinically appropriate and aligned with your injury and recovery plan. If an insurer refuses to approve a treatment, or caps the number of sessions, you have a right to request a review of that decision. The insurer must provide a written explanation for any refusal or limitation.
SIRA (the State Insurance Regulatory Authority) oversees CTP claims in NSW and provides guidance on dispute resolution. If you disagree with an insurer’s decision, you may request a review under the insurer’s internal dispute resolution process. This must be completed within 30 days of receiving the decision. If the dispute remains unresolved, you may escalate it to the Personal Injury Commission (PIC), which has authority to review and determine disputes about treatment and care, including those involving medical practitioners and rehabilitation providers.
Preparing for a Medical Assessment
When a dispute arises over treatment, you may be required to attend a medical assessment. This is typically arranged by the insurer or SIRA to assess your injury, treatment needs and functional capacity. In regional NSW, these assessments may be scheduled at a regional medical centre, a SIRA-approved assessment provider, or a specialist clinic. You should prepare by:
- Gathering all medical records related to your injury, including reports from your treating practitioner, imaging results, and rehabilitation progress notes.
- Providing a written summary of your symptoms, treatment history, and any limitations affecting daily activities.
- Bringing a list of medications, therapy sessions completed, and any changes in your condition since the accident.
- Ensuring you have contact details for your treating medical practitioner and any allied health providers involved in your care.
It is important to attend the assessment on time and to bring any supporting evidence. Your attendance is not an admission of fault or acceptance of the insurer’s position. It is a procedural step to provide information that may help resolve the dispute.
SIRA’s Role in Rehabilitation Planning and Dispute Resolution
SIRA’s rehabilitation planning rules require that treatment and care plans be developed in consultation with the claimant and their medical practitioners. These plans must be individualised, evidence-based and updated as your recovery progresses. If your insurer has not approved a treatment that is part of your approved rehabilitation plan, you may request that SIRA review the decision. SIRA may intervene to ensure that treatment is not delayed or denied on the basis of cost or administrative policy.
If a dispute involves a disagreement between your treating practitioner and the insurer about the need for a specific treatment, SIRA may arrange a medical review. This review is conducted by an independent medical practitioner approved by SIRA. The review will assess whether the treatment is reasonable and necessary in relation to your injury and recovery goals. The outcome of the review may result in the insurer being required to approve the treatment.
Key Considerations for Regional Claimants
In regional NSW, claimants face unique challenges in accessing medical assessments and treatment. These include:
- Limited availability of specialists and allied health professionals, particularly in remote or rural areas.
- Longer travel times and higher transport costs to reach assessment locations.
- Delays in scheduling assessments due to provider availability.
To address these challenges, you should:
- Notify your insurer as soon as possible if you are unable to attend a scheduled assessment due to travel or health reasons.
- Request that assessments be conducted via telehealth where clinically appropriate and approved by SIRA.
- Ask your insurer to cover reasonable travel and accommodation costs if you must travel to attend an assessment.
SIRA has a duty to ensure that regional claimants are not disadvantaged by geographic location. Insurers must make reasonable efforts to accommodate regional claimants, including by arranging assessments closer to home or using remote assessment options.
Time Limits and Dispute Pathways
There are time limits for challenging insurer decisions. You must request an internal review within 30 days of receiving a written refusal or limitation. If the review is not resolved within 30 days, you may apply to the Personal Injury Commission (PIC) within 60 days of the review outcome. The PIC has authority to determine disputes about treatment, care, and rehabilitation, including those involving medical practitioners.
A challenge does not guarantee a change in decision. The PIC will assess whether the treatment is reasonable and necessary under the Motor Accident Injuries Act 2017. You may be required to attend a medical assessment as part of the PIC process. The PIC may also request additional medical evidence from your treating practitioner.
Hypothetical Example: A Regional Claimant’s Experience
A 42-year-old woman in Wagga Wagga was involved in a motor accident in February 2026. She sustained a soft tissue injury to her neck and back, and her physiotherapist recommended 12 weeks of manual therapy. Her insurer approved only six sessions and declined to fund further treatment. She requested a review, but the insurer maintained its decision. She contacted SIRA, who confirmed that her treatment plan was clinically appropriate. SIRA arranged a medical review, which concluded that the full 12-week course was reasonable and necessary. The insurer was required to fund the remaining six sessions. The woman was also able to claim travel expenses for attending assessments in Albury.
Next Steps and Seeking Advice
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.