Insurers make decisions under the scheme rules, and sometimes those decisions go against you. For people in Edgecliff, the way to challenge them is the same as anywhere in NSW: ask for an internal review, generally within 28 days, then apply to the Personal Injury Commission if you still disagree. Our free claim check helps you work out whether a challenge is worth making and who can help.
Eastern Suburbs · CTP claim denied
Edgecliff: next steps for a refused CTP claim
Internal review first, then the Personal Injury Commission. Check your options free, by phone or online.
Postcode: 2027
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Disputing a claim while living in Edgecliff
If Prince of Wales Hospital or St Vincent's Hospital records support your case, include them with your review request. Fresh medical evidence can be what changes a decision on review. At around 3 km from the Sydney CBD, living in Edgecliff 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 Edgecliff, within Woollahra Municipal 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
- Eastern Suburbs
- Postcode
- 2027
- From the Sydney CBD
- ~3 km
- Local government area
- Woollahra Municipal Council
Most decisions can be challenged
A decision you disagree with is a reason to act, not to give up. Start with the reasons in the letter. Some refusals turn on missing information you can supply. Others turn on a legal question, such as fault or the threshold definition, where advice helps. Either way, the review path is open for most decisions.
Read next:CTP claim denied?
Asking for an internal 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.
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 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
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.
Free claim check
Disagree with a decision? Start here
A free, no-obligation claim check by phone or online. We'll look at the decision and the deadline, and connect you with an independent lawyer if needed.
Medical and threshold disputes
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”
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.
- You were found wholly or mostly at fault
- Weekly payments were stopped or reduced
- A treatment request was declined
- The insurer says the injury wasn't caused by the crash
Read next:Claim denied? Quick check
The Personal Injury Commission
The Personal Injury Commission, or PIC, is an independent tribunal that started on 1 March 2021. In the CTP scheme it handles merit review, medical assessment, miscellaneous claims assessment and claims assessment of damages claims. It replaced the older dispute bodies, so older material that sends you elsewhere is out of date.
Read next:The Personal Injury CommissionPIC disputes explained
Paying for help with a review
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?
Your review path
Most CTP decisions follow the same review path. The deadlines are short, so it helps to know the order before you start. Complaints about how the insurer behaves are a separate track.
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 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
If your concern is how the insurer has treated you, such as delays or poor communication, that's a complaint, not a dispute. The Independent Review Office handles those complaints on 13 94 76.
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
Whether you need a lawyer depends on what was decided and what's at stake. Use these lists to get a sense of it, then get a free claim check for your own situation.
Often worth talking to a lawyer
- The refusal is based on your claim being late
- Weekly payments were stopped and you can't work
- You were driving for work and the insurer has refused on that basis
- You've missed the review deadline
You may not need one
- Your doctor can clearly answer the insurer's question in a report
- A treatment request was declined for lack of information you can supply
- You mainly want to complain about delays or communication
When treatment is declined, the fix is often a clearer explanation of why it's needed. We can connect you with doctors and allied health who know how the scheme assesses requests and what a Certificate of Fitness should record.
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 Edgecliff
- 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 Edgecliff
- If you haven't had a decision yet and are still getting the claim in, start with the CTP claims page for Edgecliff. CTP claims in Edgecliff
Frequently asked questions
Not in the usual sense. If you were driving for work, or the crash otherwise happened in the course of your work, workers compensation through your employer's insurer is generally the claim to make first, and CTP statutory benefits are generally not payable where workers compensation is available. That's a question of which scheme applies, not a finding about your injury. A CTP damages claim against the at-fault driver's insurer may still be possible, so get advice. The work quick check is a sensible first step.
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.
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.
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 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.
CTP claim denied: suburbs near Edgecliff
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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.