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 Maianbar, 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
Starting a CTP dispute from Maianbar
Internal review first, then the Personal Injury Commission. Check your options free, by phone or online.
Postcode: 2230
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Challenging a decision from Maianbar
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. 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. At around 24 km from the Sydney CBD, living in Maianbar 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.
- Region
- Sutherland Shire
- Postcode
- 2230
- Local government area
- Sutherland Shire Council
- Distance to Sutherland
- ~8 km
Most decisions can be challenged
Insurers make decisions under the scheme rules: whether to accept a claim, how much to pay, which benefits to approve, 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?
Making your internal review count
An internal review is a fresh look at the decision by the insurer. Ask in writing, generally within 28 days of receiving the decision. Say which decision you disagree with, why you think it's wrong and what outcome you want. Attach anything new: an updated report, payslips, photos or witness details.
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 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
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 the evidence points the other way, a written report addressing the insurer's reasons 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”
Free claim check
Disagree with a decision? Start here
Call (02) 7238 7379 or start online. A free claim check helps you understand the decision and your next step before the deadline.
Common reasons a claim is refused or limited
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 the evidence shows 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
- The crash is being treated as a work injury
- A treatment and care request was declined
- Your pre-accident earnings were set lower than you expected
Read next:Claim denied? Quick check
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.
The Personal Injury Commission
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
Paying for help with a review
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?
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.
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
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.
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
- Your injury was classed as threshold and it affects a damages claim
- The dispute is heading to the Personal Injury Commission
- The whole claim has been refused
- You were driving for work and the insurer has refused on that basis
You may not need one
- You mainly want to complain about delays or communication
- You agree with the decision once it's explained
- A request was declined only because some information was missing
For statutory benefits disputes on accidents from 1 December 2017, SIRA's free CTP Legal Advisory Service can help before internal review starts. CTP Assist on 1300 656 919 can connect you with it. The Personal Injury Commission
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 Maianbar
- When the real argument is how serious your injury is, the injury compensation page for Maianbar covers impairment and the threshold line. Injury compensation lawyer in Maianbar
- 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 Maianbar
Frequently asked questions
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.
First, check the letter for the reason. Payments may stop because the insurer says you can work, because your benefit period has ended, or for another reason under the scheme rules. If you disagree, ask for an internal review, generally within 28 days. Keep your Certificates of Fitness up to date in the meantime, and get advice if you can't work.
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.
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.
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.
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 not receiving the letter or being unable to manage your affairs. Don't assume the door is closed without checking.
CTP claim denied: suburbs near Maianbar
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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.