Hawkesbury · CTP claim denied

CTP claim rejected? Review options for Colo

Internal review first, then the Personal Injury Commission. Check your options free, by phone or online.

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 Colo 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.

Postcode: 2756

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  • Helping people in Colo & Glossodia

Colo: reviews without the travel

Riders on Bells Line of Road or Putty Road who came off alone may find benefits limited because of fault. If you disagree with a fault finding, you can generally ask for an internal review. There's no need to get to Windsor, or anywhere else, to dispute a decision. From Colo, review requests are generally made in writing, the lawyer you speak with can advise by phone, and the claim check works by phone and online too. Your review rights don't depend on your council, whether that's Hawkesbury City Council or any other. Internal reviews and the Personal Injury Commission work the same way across NSW.

Region
Hawkesbury
Postcode
2756
Distance to Windsor
~22 km
Local government area
Hawkesbury City Council

You can ask for a second look

Before deciding what to do, pin down three things: exactly what was decided, the reasons given, and the date you received the letter. The first two tell you what evidence might change the outcome. The third starts the clock, because an internal review is generally requested within 28 days. With those in hand, choosing between a review on your own and getting advice becomes much clearer.

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

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

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Complaints versus disputes

A dispute is about a decision, such as whether your claim is accepted. A complaint is about conduct, such as delays, unanswered calls or unclear letters. Complaints about the conduct of CTP insurers go to the Independent Review Office (IRO) on 13 94 76, 8:30am to 5:30pm weekdays, or online at iro.nsw.gov.au. The IRO doesn't fund lawyers for CTP claims.

Common reasons a claim is refused or limited

Not every decision is a flat refusal. Sometimes the claim is accepted but limited: benefits capped at 52 weeks, weekly payments set lower than you expected, or a particular treatment declined. These partial decisions can matter as much as a refusal over time, and most can be reviewed in the same way.

  • The injury was classed as a threshold injury
  • The crash is being treated as a work injury
  • Weekly payments were stopped or reduced
  • The insurer says the injury wasn't caused by the crash

Read next:Claim denied? Quick check

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.

If the review confirms the original decision, that isn't the end. You can generally take most disputes to the Personal Injury Commission. If the review changes the decision, check the new letter carefully to make sure it covers everything you raised, and ask about anything it leaves out.

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

Legal costs in a dispute

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?

How to challenge a CTP decision, step by step

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.

  1. 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.

  2. Within 28 days

    Ask for an internal review

    Request the review in writing, inside the 28-day window that generally applies. The insurer looks at the decision again, so explain clearly why you think it's wrong and attach anything it didn't have.

  3. 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.

  4. 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.

  5. 28 days from a certificate

    Medical assessment review

    Medical assessment certificates can generally be reviewed, but the window is short: generally 28 days from the date the certificate is issued. Get advice quickly if you're considering it.

  6. 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

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

  • You've missed the review deadline
  • You were driving for work and the insurer has refused on that basis
  • Your injury was classed as threshold and it affects a damages claim
  • The refusal is based on your claim being late

You may not need one

  • You agree with the decision once it's explained
  • A treatment request was declined for lack of information you can supply
  • The decision was about a small, one-off expense

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 Colo
  • When the real argument is how serious your injury is, the injury compensation page for Colo covers impairment and the threshold line. Injury compensation lawyer in Colo
  • If you haven't had a decision yet and are still getting the claim in, start with the CTP claims page for Colo. CTP claims in Colo

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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.

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