The NSW CTP Claim Process: What Happens and When

Stage 1: Lodging the claim (the first weeks)

The claim starts when you lodge the Application for Personal Injury Benefits with the insurer, ideally within 28 days of the accident. The insurer acknowledges it, gives you a claim number and assigns a case manager. See how to make a CTP claim.

In these early weeks the insurer is gathering information: your Certificate of Fitness, medical records, employment details and accident information. Answering requests quickly keeps payments and treatment approvals moving.

Stage 2: The insurer's early decisions

Several decisions made early in the claim shape everything that follows. The insurer's letters should explain each decision and your review rights.

• Liability and fault: whether the insurer accepts the claim, and whether it says you were wholly or mostly at fault.
• Injury type: whether your injury is a threshold injury (generally soft tissue or threshold psychological injury) or more than that.
• Weekly payments: how much you are paid, based on your pre-accident earnings.
• Treatment and care: which treatment requests are approved as reasonable and necessary.

Stage 3: Ongoing benefits and insurer medical examinations

While you recover, the claim runs on updated Certificates of Fitness, treatment requests and progress reports from your doctor and any allied health providers, such as a physiotherapist or psychologist. If you need a doctor experienced with CTP claims, see doctors and allied health. The insurer may also ask you to attend an independent medical examination with a practitioner it chooses. You generally need to attend, and the report can influence decisions about your treatment, capacity for work and injury type.

Keep your own records consistent and complete. If an insurer report doesn't match what your treating practitioners are saying, that difference is often what a later dispute turns on.

Stage 4: The 52-week mark

For accidents on or after 1 April 2023, statutory benefits for threshold injuries generally end at 52 weeks. The same 52-week limit generally applies to people who were wholly or mostly at fault. If your injury is more than a threshold injury and you were not mostly at fault, benefits can continue, although weekly payments after 52 weeks may be reduced for contributory negligence.

If you are approaching 52 weeks and your benefits are about to stop, that is a good moment to get advice, particularly if you think the injury classification or fault decision is wrong.

Stage 5: The damages claim

If you are eligible, the damages claim is the lump-sum part of the claim. It generally can't be made until 20 months after the accident, unless your whole person impairment is assessed as more than 10%. It must generally be made within 3 years of the accident.

There is another date to watch. Weekly payments generally stop after 104 weeks (2 years), but can continue while a damages claim is pending, which generally requires the damages claim to be lodged within 2 years of the accident. See CTP damages claims.

Stage 6: Resolution

Most damages claims end in a negotiated settlement. A damages claim generally can't be settled within 2 years of the accident unless your whole person impairment is more than 10%. If the parties can't agree, the claim can go to the Personal Injury Commission for assessment. See CTP settlements.

Disputes can happen at any stage

If the insurer makes a decision you disagree with, you can generally ask it for an internal review within 28 days of receiving the decision. If that doesn't resolve it, the dispute can go to the Personal Injury Commission. Those windows are short, so don't let a decision letter sit. See CTP claim denied.

When to talk to a lawyer

You don't need a lawyer to lodge a CTP claim, and plenty of people with short, straightforward claims never use one. SIRA also funds a free CTP Legal Advisory Service for statutory benefits questions. It is worth talking to an independent CTP claim lawyer if:

• The insurer has made a decision about fault, injury type or weekly payments that you think is wrong.
• Your benefits are about to stop at the 52-week mark.
• You may be eligible for damages and are approaching the 2-year or 3-year dates.
• The insurer has made a settlement offer.