Insurers make decisions under the scheme rules, and sometimes those decisions go against you. For people in McMahons Point, 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.
Lower North Shore & Ryde · CTP claim denied
Insurer said no? CTP dispute options in McMahons Point
Insurers make decisions under the scheme rules. You can challenge them, and an independent lawyer can help.
Postcode: 2060
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- Helping people in McMahons Point & Lavender Bay
What a review looks like from McMahons Point
After a crash on Military Road or the Pacific Highway, some people find the insurer slow to reply rather than wrong. Delays and poor communication are complaints for the Independent Review Office, on 13 94 76, not disputes. People in McMahons Point, within North Sydney 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. At around 3 km from the Sydney CBD, living in McMahons Point 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
- Lower North Shore & Ryde
- Postcode
- 2060
- Local government area
- North Sydney Council
- From the Sydney CBD
- ~3 km
A refusal isn't the end of the road
Before deciding what to do, pin down three things: exactly what was decided, the reasons given, and the date you received the letter. The first two tell you what evidence might change the outcome. The third starts the clock, because an internal review is generally requested within 28 days. With those in hand, choosing between a review on your own and getting advice becomes much clearer.
Read next:CTP claim denied?
The Personal Injury Commission
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
Complaints versus disputes
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.
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Threshold and assessment disputes
Disputes about injuries often come down to evidence. If the insurer says your injury is threshold, or that treatment and care isn't reasonable and necessary, the answer is usually a clear written report that deals with the insurer's reasons. If the dispute reaches medical assessment at the Commission, a certificate review must generally be sought within 28 days of issue.
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 the evidence shows only soft tissue injury, it may classify it as threshold. Knowing the reason tells you what evidence to gather.
- The claim was lodged late
- Weekly payments were stopped or reduced
- A treatment and care request was declined
- Your pre-accident earnings were set lower than you expected
Read next:Claim denied? Quick check
Making your internal review count
Reviews are often decided on the papers, so what you send matters. If the decision was about your injury, send any report that deals with the point the insurer relied on. If it was about earnings, send payslips or tax records. If it was about fault, include police details, photos and witness contacts.
Don't wait until the last days of the window to start. Reports and records can take time to arrive, and a rushed request is usually weaker. If some evidence won't be ready in time, lodge the request within the deadline anyway and tell the insurer what else is on its way.
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
Paying for help with a review
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?
From decision letter to the Commission
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 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
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.
Do you need a lawyer to challenge a decision?
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 dispute is heading to the Personal Injury Commission
- Your injury was classed as threshold and it affects a damages claim
- The whole claim has been refused
- Weekly payments were stopped and you can't work
You may not need one
- A request was declined only because some information was missing
- You mainly want to complain about delays or communication
- The decision matches what your own paperwork shows
If your complaint is about how the insurer is handling your claim, such as delays or poor communication, rather than the decision itself, the Independent Review Office deals with it on 13 94 76. PIC disputes explained
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 McMahons Point is the better fit. CTP lawyer in McMahons Point
- When the real argument is how serious your injury is, the injury compensation page for McMahons Point covers impairment and the threshold line. Injury compensation lawyer in McMahons Point
- If you haven't had a decision yet and are still getting the claim in, start with the CTP claims page for McMahons Point. CTP claims in McMahons Point
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.
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. Clear evidence about the injury 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.
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.
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 documents that show why you couldn't claim sooner, and speak to a lawyer straight away.
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 McMahons 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.