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 Cobbitty 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.
Macarthur & Wollondilly · CTP claim denied
Starting a CTP dispute from Cobbitty
The insurer's decision is rarely the last word. The first deadline is generally 28 days, so start now.
Postcode: 2570
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Disputing a claim while living in Cobbitty
Crashes on Picton Road or Appin Road involving heavy vehicles can lead to fault disputes. If the insurer has decided you were mostly at fault, that finding can generally be reviewed, and a lawyer can advise on how. Cobbitty is about 13 km north-west of Campbelltown, but challenging a decision doesn't mean travelling there. Internal reviews are generally requested in writing, and our claim check runs by phone and online. Your review rights don't depend on your council, whether that's Camden Council or any other. Internal reviews and the Personal Injury Commission work the same way across NSW.
- Region
- Macarthur & Wollondilly
- Postcode
- 2570
- Distance to Campbelltown
- ~13 km
- Local government area
- Camden Council
A refusal isn't the end of the road
Insurers make decisions under the scheme rules: whether to accept a claim, how much to pay, what treatment to fund, whether an injury is threshold. Most of them can be challenged. The first step is an internal review, which you generally need to request within 28 days of the decision reaching you. If that doesn't resolve it, the Personal Injury Commission can decide.
Read next:CTP claim denied?
The IRO and what it handles
CTP Assist and the IRO are different services with different roles. CTP Assist, on 1300 656 919, gives information and support about claims. The IRO, on 13 94 76, handles complaints about how CTP insurers behave. Neither decides disputes about your entitlements; that's the job of internal review and the Personal Injury Commission.
The decisions behind many disputes
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
- You were found wholly or mostly at fault
- Weekly payments were stopped or reduced
- The insurer says the injury wasn't caused by the crash
Read next:Claim denied? Quick check
Free claim check
Check your review options, free
No office visit and no charge for the check. A quick claim check by phone or online tells you whether a review is worth pursuing.
Taking a dispute further
If an internal review doesn't resolve your dispute, the Personal Injury Commission is generally the next step. It's independent of the insurer. Depending on the dispute, a member may review the decision on its merits, a medical assessor may assess your injury, or the Commission may assess a damages claim. The type of dispute decides which path applies.
Read next:The Personal Injury CommissionPIC disputes explained
How to request a review
A good review request is short and specific. Quote the decision and its date. Explain in plain terms where you think the insurer got it wrong, with reference to the evidence. If there's something the insurer didn't have, such as a specialist report, include it. Keep a copy and note when you sent it.
Don't wait until the last days of the window to start. Specialist reports and records can take time to arrive, and a rushed request is usually weaker. If some evidence won't be ready in time, lodge the request within the deadline anyway and tell the insurer what else is on its way.
The 28-day window
The clock generally runs for 28 days from the day the decision reached you. Note the date the letter arrived, not just the date printed on it.
Read next:Insurer stopped my weekly payments
Disputing a threshold-injury decision
Medical disputes often come down to evidence. If the insurer says your injury is threshold, or that treatment isn't reasonable and necessary, the answer is usually a clear report from your treating doctor or specialist explaining the diagnosis and the need. If the dispute reaches medical assessment at the Commission, a certificate review must generally be sought within 28 days of issue.
Read next:Threshold injury disputesWhen the insurer says “threshold injury”
Legal costs in a dispute
In a dispute about statutory benefits, legal costs work differently from what many people expect. Costs are recoverable only where the Regulation or the Personal Injury Commission allows, the insurer pays whatever is recoverable, and in some disputes nothing can be recovered at all. So before you engage a lawyer for a review, ask how their fees would work for this particular dispute, and get the answer in writing.
Read next:What does a CTP lawyer cost?
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
Note the date you received it, what was decided and the reasons given. The date matters, because the time to ask for a review generally runs from when you receive the decision.
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
The insurer usually has 14 days to decide the review. For some medical and miscellaneous matters it's 21 days, and up to 28 days if it needs more information from you.
If you still disagree
Apply to the Personal Injury Commission
If internal review leaves the decision in place, the next step is generally an application to the Personal Injury Commission, an independent tribunal. What you're disputing decides which of its paths applies, such as merit review or medical assessment.
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.
Reviewing alone or with legal help
Some reviews are simple: supply the missing evidence and ask again. Others turn on legal questions or high stakes. Here's a general guide to which is which.
Often worth talking to a lawyer
- You've missed the review deadline
- The whole claim has been refused
- Your injury was classed as threshold and it affects a damages claim
- Weekly payments were stopped and you can't work
You may not need one
- You mainly want to complain about delays or communication
- A treatment request was declined for lack of information you can supply
- The insurer asked for a document you can easily provide
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?
- For the wider question of whether a lawyer is worth it on a CTP claim at all, the CTP lawyer page for Cobbitty is the better fit. CTP lawyer in Cobbitty
- If the dispute turns on whether your injury is more than threshold, the injury compensation page explains what the medical evidence needs to show. Injury compensation lawyer in Cobbitty
- If nothing has been decided yet and your claim is still being set up, the CTP claims page covers the lodging steps instead. CTP claims in Cobbitty
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.
Generally yes. If your dispute went to medical assessment at the Personal Injury Commission and you think the certificate is wrong, you can seek a review, but it must generally be sought within 28 days of the certificate being issued. The grounds for a review are generally limited, so it's worth getting advice quickly about whether a review is likely to be accepted.
First, check the letter for the reason. Payments may stop because the insurer says you can work, because your benefit period has ended, or for another reason under the scheme rules. If you disagree, ask for an internal review, generally within 28 days. Keep your Certificates of Fitness up to date in the meantime, and get advice if you can't work.
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.
Generally 28 days from receiving the decision. Ask in writing, say which decision you disagree with and why, and include any new evidence. Because the window is short, don't wait for every document before you lodge the request. If you're close to the deadline or past it, get advice quickly.
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.
CTP claim denied: suburbs near Cobbitty
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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.