A letter refusing your CTP claim can feel final. It usually isn't. Most insurer decisions can be challenged, first by internal review and then at the Personal Injury Commission. If you live in Castlecrag and the insurer has said no, our free claim check looks at the decision and its deadlines, and connects you with an independent CTP lawyer if a dispute is worth pursuing. Some aren't, and we'll tell you.
Lower North Shore & Ryde · CTP claim denied
Castlecrag: next steps for a refused CTP claim
Calm, clear steps for a refused claim, stopped payments or a threshold decision you disagree with.
Postcode: 2068
- Free claim check, no obligation
- By phone & online, no office to visit
- Helping people in Castlecrag & Northbridge
From decision letter to the Commission
Here's the usual route when you disagree with an insurer's decision. Not every dispute needs every step, and some decisions have their own rules, but this is the general shape.
Step 1
Read the decision letter
Read the letter twice: once for what was decided, once for why. Write down the date you received it. If the reasons aren't clear, ask the insurer to explain them in writing.
Within 28 days
Ask for an internal review
For most decisions, you can ask the insurer for an internal review, generally within 28 days of receiving the decision. Say what you disagree with and include any new evidence.
14 to 28 days
The insurer decides
Expect a review decision in about 14 days in most cases, 21 days for some medical and miscellaneous matters, and up to 28 days where the insurer needs more information.
If you still disagree
Apply to the Personal Injury Commission
If the internal review doesn't resolve things, you can generally apply to the Personal Injury Commission. It's independent of the insurer and decides disputes under the scheme rules.
28 days from a certificate
Medical assessment review
If your dispute goes to medical assessment and you think the certificate is wrong, a review must generally be sought within 28 days of the certificate being issued.
Any time
Conduct complaints go to the IRO
Unhappy with the insurer's conduct rather than its decision? Contact the Independent Review Office on 13 94 76, 8:30am to 5:30pm weekdays, or online. It's a separate path from a review.
General information, not legal advice. Timeframes are general, and some decisions follow different rules. Check your decision letter and get advice quickly.
Disputing a claim while living in Castlecrag
If Royal North Shore Hospital or Ryde Hospital records show an injury the insurer has overlooked, that's review material. Include it when you ask for an internal review, and keep copies of everything you send. At around 8 km from the Sydney CBD, living in Castlecrag is no disadvantage in a dispute. Review requests generally go in writing, many Personal Injury Commission steps can happen by phone or online, and our claim check works the same way. People in Castlecrag, within Willoughby City Council, follow the same dispute path as everyone else in NSW: internal review first, generally within 28 days, then the Personal Injury Commission. Where you live doesn't change the deadlines.
- Region
- Lower North Shore & Ryde
- Postcode
- 2068
- Distance to Chatswood
- ~3 km
- Local government area
- Willoughby City Council
A refusal isn't the end of the road
It's easy to read a refusal as the final word. Under the NSW CTP scheme, it's usually the first. Most decisions carry a right to internal review, and beyond that an independent tribunal, the Personal Injury Commission. What you need is a clear understanding of the decision and enough time to respond, which is why the 28-day window matters.
Read next:CTP claim denied?
Disputing a threshold-injury decision
A threshold decision about a psychological injury can be disputed like any other. If the insurer has classified yours as threshold and your treating practitioner disagrees, their written opinion is the starting point for an internal review. If the review doesn't resolve it, the dispute can go on to medical assessment at the Personal Injury Commission, where the 28-day window for a certificate review applies.
Read next:Threshold injury disputesWhen the insurer says “threshold injury”
What the Commission does
Applying to the Commission is more formal than an internal review. There are forms, timeframes and evidence rules, and the insurer will usually have its own representatives. Many people get legal advice at this stage. Keep in mind that SIRA's free CTP Legal Advisory Service doesn't cover matters already at the Commission.
Read next:The Personal Injury CommissionPIC disputes explained
Free claim check
Disagree with a decision? Start here
The claim check is free and carries no obligation. Tell us what the insurer decided, and we'll point you to the right help.
When a dispute calls for legal help
Many people handle an internal review themselves. Disputes that reach the Personal Injury Commission, or that affect a damages claim, are where legal advice more often helps.
Often worth talking to a lawyer
- Weekly payments were stopped and you can't work
- Your injury was classed as threshold and it affects a damages claim
- You've been found mostly at fault
- The refusal is based on your claim being late
You may not need one
- The decision was about a small, one-off expense
- Your doctor can clearly answer the insurer's question in a report
- You agree with the decision once it's explained
Many disputes turn on medical evidence. If you need a clear report on your diagnosis, or an up-to-date Certificate of Fitness, we can point you to doctors and allied health familiar with CTP claims.
Not quite your situation?
- If you're not sure a dispute is worth taking on with legal help, the CTP lawyer page explains when a lawyer tends to be worth it. CTP lawyer in Castlecrag
- When the real argument is how serious your injury is, the injury compensation page for Castlecrag covers impairment and the threshold line. Injury compensation lawyer in Castlecrag
- If you haven't had a decision yet and are still getting the claim in, start with the CTP claims page for Castlecrag. CTP claims in Castlecrag
Asking for an internal review
Reviews are often decided on the papers, so what you send matters. If the decision was about your injury, ask your treating doctor to explain their findings in writing. If it was about earnings, send payslips or tax records. If it was about fault, include police details, photos and witness contacts.
After you ask, the insurer usually has 14 days to decide. Some medical and miscellaneous matters allow 21 days, and up to 28 days if the insurer needs more information. While you wait, keep sending updated Certificates of Fitness if you're off work, and keep a record of every contact about the review.
The 28-day window
The review deadline is short: generally 28 days from receiving the decision. If you're unsure which date counts, work from the earlier one.
Read next:Insurer stopped my weekly payments
Decisions people often ask about
The reasons vary, but some patterns are familiar. If you were driving for work, the insurer may say workers compensation comes first. If the claim was more than 3 months late, it may say your explanation isn't enough. If your scans show only soft tissue injury, it may classify it as threshold. Knowing the reason tells you what evidence to gather.
- The claim was lodged late
- The injury was classed as a threshold injury
- The crash is being treated as a work injury
- A treatment request was declined
Read next:Claim denied? Quick check
Complaints versus disputes
It helps to keep a dispute and a complaint apart. If the problem is the outcome, use internal review and then the Personal Injury Commission. If the problem is the way the insurer is handling your claim, the Independent Review Office can take a complaint. Sometimes both apply, and it's fine to use each path for a different part of the problem.
What a dispute might cost
Free help is limited once a dispute is under way. The CTP Legal Advisory Service that SIRA funds stops short of matters already at internal review or before the Personal Injury Commission. CTP Assist can still give general information. For advice on the dispute itself, you'll generally need an independent lawyer.
Read next:What does a CTP lawyer cost?
Frequently asked questions
Sometimes, but it's limited. For a statutory benefits dispute, legal costs are recoverable from the insurer only where the Regulation or the Personal Injury Commission allows, and some disputes allow no recovery at all. Ask any lawyer, before they start, what the costs position is for your specific dispute, and get it in writing.
Yes. You can generally ask for an internal review, then take the dispute to the Personal Injury Commission. The label generally covers soft tissue injuries and threshold psychological injuries; nerve damage, and a full or partial tear of a tendon, ligament, meniscus or cartilage, fall outside it. Evidence from your treating doctor or specialist is usually central to the outcome.
Not necessarily, but act now. Some decisions may still be open to challenge, and the rules can depend on the type of decision and your circumstances. Speak to a lawyer as soon as you can, and gather anything that explains the delay, such as a hospital stay or not receiving the letter. Don't assume the door is closed without checking.
It's an independent tribunal that started on 1 March 2021 and decides disputes in the NSW CTP scheme. Its CTP work covers merit review, medical assessment, miscellaneous claims assessment and the assessment of damages claims. You can generally apply once an internal review hasn't resolved the dispute. It replaced the dispute bodies used before 2021, so older information you find online may be out of date.
The Independent Review Office (IRO) takes complaints about how CTP insurers behave: call 13 94 76, 8:30am to 5:30pm weekdays, or go to iro.nsw.gov.au. Typical complaints are delays, poor communication or requests that go unanswered. A complaint is different from a dispute about a decision, which goes through internal review and the Personal Injury Commission.
Only in part. SIRA's CTP Legal Advisory Service gives free advice on statutory benefits for accidents from 1 December 2017, but it doesn't cover matters already at internal review or the Personal Injury Commission, damages claims or older-scheme claims. It may help before you request a review. Once a dispute is under way, you'd generally need an independent lawyer.
CTP claim denied: suburbs near Castlecrag
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CTP Lawyer is not a law firm. This page is general information, not legal advice; the independent lawyer you speak with can advise on your own situation.