If your CTP claim was denied after a U-turn collision in NSW, you have legal options to challenge the insurer's decision. This article explains how to dispute a denied claim under NSW law, including the role of SIRA, evidence you may need, and next steps.
Understanding Why an Insurer May Deny a Claim
Insurers must provide a written explanation for denying a CTP claim, including the legal basis for refusal. Common reasons include disputes over fault, injury severity, or claimant eligibility. Under the Motor Accident Injuries Act 2017, insurers cannot refuse claims without a valid reason. If the insurer's decision is unclear or you believe it is incorrect, you can request a review.
How to Challenge a Denied CTP Claim
If your claim is denied, you may:
- Request a written explanation from the insurer detailing why the claim was rejected.
- Submit a formal dispute to SIRA within 28 days of the insurer's decision.
- Appeal to the NSW Civil and Administrative Tribunal (NCAT) if the dispute is not resolved.
SIRA oversees the CTP scheme and provides a formal process for resolving disputes. They may order the insurer to pay if they find the refusal was unjustified. However, disputes are not guaranteed to succeed. The insurer must prove your claim does not meet the legal criteria for compensation.
Evidence to Support Your Dispute
To challenge a denied claim, gather:
- Medical records showing your injury meets the threshold for compensation (e.g., soft tissue injury with neurological signs).
- Accident documentation such as police reports, witness statements, and photographs of the U-turn collision.
- Evidence of income loss if you're claiming weekly payments.
- Independent medical opinions to challenge the insurer's assessment of your injury.
Common Mistakes to Avoid
Avoid these errors that weaken your dispute:
- Failing to provide sufficient medical evidence to prove your injury meets the threshold.
- Missing the 28-day deadline to dispute the insurer's decision.
- Assuming the insurer's refusal is final without seeking independent review.
- Confusing statutory benefits (like weekly payments) with common law damages.
When to Seek Legal Advice
Consult a solicitor if your dispute involves complex issues such as:
- Disputes over the severity of a threshold injury.
- Claims for lifetime care or long-term impairment.
- Conflicts with the insurer's interpretation of the Motor Accident Guidelines.
- Overlapping with workers' compensation or other insurance.
Legal professionals can help you navigate the CTP scheme, prepare dispute submissions, and challenge the insurer's position.
Next Steps After a Denied Claim
If your insurer denies your claim, you have the right to challenge their decision through the formal dispute process. SIRA and NCAT provide mechanisms to review claims, but success depends on the strength of your evidence and legal arguments. Always act promptly to preserve your rights.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.