A refused claim is a decision, not a verdict. Under the NSW CTP scheme, most insurer decisions can be reviewed, and there's an independent body, the Personal Injury Commission, if an internal review doesn't resolve things. Our free claim check helps people in Huntleys Point understand the decision, the deadlines and whether an independent lawyer would help.
Lower North Shore & Ryde · CTP claim denied
Huntleys Point: next steps for a refused CTP claim
Internal review first, then the Personal Injury Commission. Check your options free, by phone or online.
Postcode: 2111
- Free claim check, no obligation
- By phone & online, no office to visit
- Helping people in Huntleys Point & Hunters Hill West
Disputing a claim while living in Huntleys Point
If Royal North Shore Hospital or Ryde Hospital records show an injury the insurer has overlooked, that's review material. Include it when you ask for an internal review, and keep copies of everything you send. Huntleys Point is about 5 km south-west of Chatswood, 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. People in Huntleys Point, within Hunter's Hill 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
- Lower North Shore & Ryde
- Postcode
- 2111
- Distance to Chatswood
- ~5 km
- Local government area
- Hunter's Hill Council
A refusal isn't the end of the road
It's easy to read a refusal as the final word. Under the NSW CTP scheme, it's usually the first. Most decisions carry a right to internal review, and beyond that an independent tribunal, the Personal Injury Commission. What you need is a clear understanding of the decision and enough time to respond, which is why the 28-day window matters.
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”
How to request a 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.
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 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
Free claim check
Check your review options, free
The claim check is free and carries no obligation. Tell us what the insurer decided, and we'll point you to the right help.
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
- The injury was classed as a threshold injury
- Weekly payments were stopped or reduced
- A treatment request was declined
Read next:Claim denied? Quick check
When your issue is how you were treated
It helps to keep a dispute and a complaint apart. If the problem is the outcome, use internal review and then the Personal Injury Commission. If the problem is the way the insurer is handling your claim, the Independent Review Office can take a complaint. Sometimes both apply, and it's fine to use each path for a different part of the problem.
Taking a dispute further
Applying to the Commission is more formal than an internal review. There are forms, timeframes and evidence rules, and the insurer will usually have its own representatives. Many people get legal advice at this stage. Keep in mind that SIRA's free CTP Legal Advisory Service doesn't cover matters already at the Commission.
Read next:The Personal Injury CommissionPIC disputes explained
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?
Your review path
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
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.
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
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.
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.
Do you need a lawyer to challenge a decision?
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
- The dispute is heading to the Personal Injury Commission
- The refusal is based on your claim being late
- You were driving for work and the insurer has refused on that basis
- You've missed the review deadline
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 insurer asked for a document you can easily provide
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 Huntleys Point
- When the real argument is how serious your injury is, the injury compensation page for Huntleys Point covers impairment and the threshold line. Injury compensation lawyer in Huntleys Point
- If you haven't had a decision yet and are still getting the claim in, start with the CTP claims page for Huntleys Point. CTP claims in Huntleys Point
Frequently asked questions
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.
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 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.
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.
CTP claim denied: suburbs near Huntleys Point
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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.