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 Menai Central, 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 Menai Central: the review path
Calm, clear steps for a refused claim, stopped payments or a threshold decision you disagree with.
Postcode: 2234
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How to challenge a CTP decision, step by step
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 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
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
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.
Challenging a decision from Menai Central
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. Menai Central is about 4 km west of Sutherland, 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.
- Region
- Sutherland Shire
- Postcode
- 2234
- Local government area
- Sutherland Shire Council
- Distance to Sutherland
- ~4 km
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?
Disputing a threshold-injury decision
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”
How to request a review
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.
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
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A free, no-obligation claim check by phone or online. We'll look at the decision and the deadline, and connect you with an independent lawyer if needed.
Reviewing alone or with legal help
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
- You've missed the review deadline
- You've been found mostly at fault
- The refusal is based on your claim being late
- Your injury was classed as threshold and it affects a damages claim
You may not need one
- The insurer asked for a document you can easily provide
- The decision was about a small, one-off expense
- 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 Menai Central is the better fit. CTP lawyer in Menai Central
- When the real argument is how serious your injury is, the injury compensation page for Menai Central covers impairment and the threshold line. Injury compensation lawyer in Menai Central
- If you haven't had a decision yet and are still getting the claim in, start with the CTP claims page for Menai Central. CTP claims in Menai Central
What the Commission does
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.
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 benefit 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 and care request was declined
- Your pre-accident earnings were set lower than you expected
Read next:Claim denied? Quick check
What a dispute might cost
In a dispute about statutory benefits, legal costs work differently from what many people expect. Costs are recoverable only where the Regulation or the Personal Injury Commission allows, the insurer pays whatever is recoverable, and in some disputes nothing can be recovered at all. So before you engage a lawyer for a review, ask how their fees would work for this particular dispute, and get the answer in writing.
Read next:What does a CTP lawyer cost?
Frequently asked questions
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.
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.
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.
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.
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.
CTP claim denied: suburbs near Menai Central
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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.