Denied, cut off or classified as a threshold injury? Start by reading the decision carefully and noting the date you received it. The internal review window is generally 28 days. People in Palm Beach can handle much of a review in writing, and an independent CTP lawyer can help if the stakes are high. Our free claim check is a quick way to find out where you stand.
Northern Beaches · CTP claim denied
Palm Beach: next steps for a refused CTP claim
Internal review first, then the Personal Injury Commission. Check your options free, by phone or online.
Postcode: 2108
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From decision letter to the Commission
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
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
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
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.
What a review looks like from Palm Beach
If your weekly payments stopped after a crash on the Wakehurst Parkway or Barrenjoey Road, ask the insurer in writing why. The reasons tell you whether an internal review is worth requesting, and the 28 days generally start when the decision reaches you. People in Palm Beach, within Northern Beaches 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. There's no need to get to Dee Why, or anywhere else, to dispute a decision. From Palm Beach, review requests are generally made in writing, the lawyer you speak with can advise by phone, and the claim check works by phone and online too.
- Region
- Northern Beaches
- Postcode
- 2108
- Local government area
- Northern Beaches Council
- Distance to Dee Why
- ~17 km
You can ask for a second look
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?
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.
- Weekly payments were stopped or reduced
- A treatment and care request was declined
- Your pre-accident earnings were set lower than you expected
- The insurer says the injury wasn't caused by the crash
Read next:Claim denied? Quick check
Free claim check
Get a clear view of your dispute
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.
Do you need a lawyer to challenge a decision?
Many people handle an internal review themselves. Disputes that reach the Personal Injury Commission, or that affect a damages claim, are where legal advice more often helps.
Often worth talking to a lawyer
- Weekly payments were stopped and you can't work
- You were driving for work and the insurer has refused on that basis
- The whole claim has been refused
- Your injury was classed as threshold and it affects a damages claim
You may not need one
- The decision matches what your own paperwork shows
- You agree with the decision once it's explained
- The insurer asked for a document you can easily provide
Start with the decision letter. Note the date it reached you, because the 28-day window for an internal review generally runs from then, and ask in writing for the reasons if they aren't clear. CTP claim denied
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 Palm Beach is the better fit. CTP lawyer in Palm Beach
- When the real argument is how serious your injury is, the injury compensation page for Palm Beach covers impairment and the threshold line. Injury compensation lawyer in Palm Beach
- If you haven't had a decision yet and are still getting the claim in, start with the CTP claims page for Palm Beach. CTP claims in Palm Beach
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.
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”
Taking a dispute further
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
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?
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 documents that show why you couldn't claim sooner, and speak to a lawyer straight away.
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.
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.
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.
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.
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.
CTP claim denied: suburbs near Palm Beach
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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.