Mid North Coast · CTP claim denied

Starting a CTP dispute from Frederickton

Insurers make decisions under the scheme rules. You can challenge them, and an independent lawyer can help.

When a CTP insurer refuses a claim or stops payments, the decision letter generally sets out its reasons. Those reasons are your starting point. For people in Frederickton, the next step is usually an internal review, then the Personal Injury Commission if needed. We can check your situation for free and, if your dispute calls for one, put you in touch with an independent CTP lawyer.

Postcode: 2440

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  • Helping people in Frederickton & Kempsey

Frederickton: reviews without the travel

If Port Macquarie Base Hospital or Coffs Harbour Health Campus records support your case, ask for them now, because the internal review window generally closes 28 days after the decision reaches you. Frederickton is about 44 km north of Port Macquarie, 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 Kempsey Shire Council or any other. Internal reviews and the Personal Injury Commission work the same way across NSW.

Region
Mid North Coast
Postcode
2440
Distance to Port Macquarie
~44 km
Local government area
Kempsey Shire 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?

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”

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
  • 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

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Taking a dispute further

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

The IRO and what it handles

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.

Making your internal review count

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 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?

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.

  1. 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.

  2. 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.

  3. 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.

  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

    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.

  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

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 whole claim has been refused
  • You've been found mostly at fault
  • The refusal is based on your claim being late
  • A medical assessment certificate seems wrong

You may not need one

  • You agree with the decision once it's explained
  • The insurer asked for a document you can easily provide
  • 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?

  • For the wider question of whether a lawyer is worth it on a CTP claim at all, the CTP lawyer page for Frederickton is the better fit. CTP lawyer in Frederickton
  • When the real argument is how serious your injury is, the injury compensation page for Frederickton covers impairment and the threshold line. Injury compensation lawyer in Frederickton
  • If you haven't had a decision yet and are still getting the claim in, start with the CTP claims page for Frederickton. CTP claims in Frederickton

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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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