The Personal Injury Commission: How NSW CTP Disputes Are Decided

What the Personal Injury Commission is

The Personal Injury Commission is an independent tribunal that decides disputes in the NSW motor accident (CTP) and workers compensation schemes. It started on 1 March 2021 and took over dispute work that was previously handled by SIRA's dispute services. It is not part of the insurer and it is not a court, although its decisions are binding and it works to formal rules.

What it decides in CTP claims

The Commission deals with four main types of CTP dispute:

• Merit review: many decisions about statutory benefits, such as how your weekly payments were calculated.
• Medical assessment: medical questions, such as whether an injury is a threshold injury, whether treatment is reasonable and necessary, and the degree of whole person impairment.
• Miscellaneous claims assessment: other claims-handling disputes set out in the rules, such as whether a late claim should be accepted.
• Claims assessment: assessing damages when a damages claim can't be settled.

How a dispute gets there

For most insurer decisions, you must first ask the insurer for an internal review, generally within 28 days of receiving the decision. The insurer usually has 14 days to decide (21 days for some medical and miscellaneous matters, and up to 28 days if it needs more information).

If you are still unhappy after internal review, or the insurer doesn't decide in time, you can apply to the Commission using its application forms. The Commission's website explains which form applies to which dispute. See CTP claim denied for the steps before the Commission.

What happens after you apply

• The insurer is notified and responds, usually with its own documents.
• Both sides provide the evidence they rely on: medical reports, earnings records, statements.
• Many matters are decided on the documents. Some involve a teleconference, a conference or a hearing.
• Medical disputes usually involve an assessment by an independent medical assessor, who may examine you.
• You receive a written decision or certificate with reasons.

Reviews and appeals

Commission decisions can be reviewed only in limited circumstances. For example, a review of a medical assessment certificate must generally be sought within 28 days of the certificate being issued, and must be based on specific grounds. Because the options after a decision are narrow, the best time to get the evidence right is before the Commission decides.

Preparing well

• Understand exactly which decision you are disputing and why.
• Get evidence that answers that question directly, such as a specialist report on the specific issue.
• Keep your documents in date order and make sure nothing important is missing.
• Meet every Commission deadline, and tell the Commission early if you need an interpreter or other support.

Costs

Legal costs in CTP statutory benefits claims are tightly regulated. You can only recover legal costs where the Regulation or the Commission allows it, and for some disputes legal costs cannot be recovered at all. For damages claims, the maximum legal costs a lawyer can charge are also capped. Ask any lawyer for a written costs agreement before they start. See what a CTP lawyer costs and CTP dispute lawyer.

When to talk to a lawyer

You can run a Commission dispute yourself, and the Commission is designed to be accessible. But procedure and evidence decide these matters. Talk to an independent CTP lawyer if:

• The dispute is about fault, a threshold injury or whole person impairment.
• The insurer has a lawyer and you don't.
• The dispute is a claims assessment of your damages.
• You have received a decision or certificate and want to know whether it can be reviewed.