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 North Bondi understand the decision, the deadlines and whether an independent lawyer would help.
Eastern Suburbs · CTP claim denied
Starting a CTP dispute from North Bondi
Calm, clear steps for a refused claim, stopped payments or a threshold decision you disagree with.
Postcode: 2026
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- By phone & online, no office to visit
- Helping people in North Bondi & Bondi Beach
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
Read the letter twice: once for what was decided, once for why. Write down the date you received it. If the reasons aren't clear, ask the insurer to explain them in writing.
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
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
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.
North Bondi: reviews without the travel
If Prince of Wales Hospital or St Vincent's Hospital records support your case, include them with your review request. Fresh medical evidence can be what changes a decision on review. At around 7 km from the Sydney CBD, living in North Bondi 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. People in North Bondi, within Waverley 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
- Eastern Suburbs
- Postcode
- 2026
- From the Sydney CBD
- ~7 km
- Local government area
- Waverley Council
Most decisions can be challenged
Insurers make decisions under the scheme rules: whether to accept a claim, how much to pay, what treatment to fund, 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?
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 injury was classed as a threshold injury
- You were found wholly or mostly at fault
- The crash is being treated as a work injury
- Your pre-accident earnings were set lower than you expected
Read next:Claim denied? Quick check
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
Free claim check
Check your review options, free
Call (02) 7238 7379 or start online. A free claim check helps you understand the decision and your next step before the deadline.
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
- You've missed the review deadline
- Weekly payments were stopped and you can't work
- 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
- The decision was about a small, one-off expense
- You agree with the decision once it's explained
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 North Bondi
- If the dispute turns on whether your injury is more than threshold, the injury compensation page explains what the medical evidence needs to show. Injury compensation lawyer in North Bondi
- If you haven't had a decision yet and are still getting the claim in, start with the CTP claims page for North Bondi. CTP claims in North Bondi
The IRO and what it handles
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.
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: a report from your doctor, hospital records, payslips or witness details.
Don't wait until the last days of the window to start. Specialist 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 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
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
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.
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.
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.
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.
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. Evidence from your treating doctor or specialist is usually central to the outcome.
CTP claim denied: suburbs near North Bondi
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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.