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 Gymea Bay, 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.
Sutherland Shire · CTP claim denied
Denied CTP claim in Gymea Bay: the review path
The insurer's decision is rarely the last word. The first deadline is generally 28 days, so start now.
Postcode: 2227
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From decision letter to the Commission
Insurers make decisions under the scheme rules, and the scheme also sets out how to challenge them. These are the main steps and the timeframes that generally apply.
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.
Challenging a decision from Gymea Bay
Weekend riders on the Royal National Park roads sometimes face fault findings they disagree with. A fault decision can generally be reviewed; start with an internal review request within 28 days of receiving the letter. At around 23 km from the Sydney CBD, living in Gymea Bay 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. Your review rights don't depend on your council, whether that's Sutherland Shire Council or any other. Internal reviews and the Personal Injury Commission work the same way across NSW.
- Region
- Sutherland Shire
- Postcode
- 2227
- Distance to Sutherland
- ~4 km
- Local government area
- Sutherland Shire Council
A refusal isn't the end of the road
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?
Making your internal review count
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 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
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.
Free claim check
Don't let the 28 days slip by
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.
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
- You've been found mostly at fault
- You were driving for work and the insurer has refused on that basis
- A medical assessment certificate seems wrong
- The whole claim has been refused
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
- Your doctor can clearly answer the insurer's question in a report
If your threshold dispute depends on whether there's nerve damage or a tear, the right assessment matters. Ask us about doctors and allied health experienced with CTP claims, from diagnosis to the Certificate of Fitness.
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 Gymea Bay
- When the real argument is how serious your injury is, the injury compensation page for Gymea Bay covers impairment and the threshold line. Injury compensation lawyer in Gymea Bay
- 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 Gymea Bay
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
Decisions people often ask about
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 claim was lodged late
- The injury was classed as a threshold injury
- A treatment request was declined
- Your pre-accident earnings were set lower than you expected
Read next:Claim denied? Quick check
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”
What a dispute might cost
Because some disputes don't allow legal costs to be recovered, it's worth asking early whether paying for help makes sense in yours. For a straightforward review, you may manage alone with good evidence. For a threshold dispute that affects a damages claim, or a refusal of the whole claim, advice is more often worth it.
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.
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.
Insurers make decisions under the scheme rules, and a refusal usually points to one of them. Common grounds include a claim lodged late, an injury classed as threshold, a finding that you were mostly at fault, or a view that the crash falls under a different scheme. The decision letter should give reasons, and those reasons tell you what evidence might change the outcome.
Once more than 3 months have passed since the accident, a claim can only be accepted in limited circumstances, usually with a full and satisfactory explanation for the delay. If the insurer rejected your explanation, you can generally ask for an internal review. Put your reasons in writing with supporting evidence, such as medical records, and speak to a lawyer straight away.
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.
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.
CTP claim denied: suburbs near Gymea Bay
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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.