Canterbury-Bankstown · CTP claim denied

CTP claim rejected? Review options for Revesby North

Insurers make decisions under the scheme rules. You can challenge them, and an independent lawyer can help.

Insurers make decisions under the scheme rules, and sometimes those decisions go against you. For people in Revesby North, 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.

Postcode: 2212

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  • Helping people in Revesby North & Revesby

How to challenge a CTP decision, step by step

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.

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

Disputing a claim while living in Revesby North

A crash on the Hume Highway, Canterbury Road or the M5 can end in a fault finding you disagree with. If the insurer's view of fault goes against you, the review window is generally 28 days, so gather police details and photos early. Revesby North is about 3 km south-west of Bankstown, 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. Coming under the City of Canterbury-Bankstown makes no difference to a CTP dispute. The same review steps and deadlines apply in Revesby North as in any other part of NSW, because the scheme is statewide.

Region
Canterbury-Bankstown
Postcode
2212
Distance to Bankstown
~3 km
Local government area
City of Canterbury-Bankstown

Most decisions can be challenged

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?

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.

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 your scans show only soft tissue injury, it may classify it as threshold. Knowing the reason tells you what evidence to gather.

  • The claim was lodged late
  • You were found wholly or mostly at fault
  • The crash is being treated as a work injury
  • Weekly payments were stopped or reduced

Read next:Claim denied? Quick check

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When a dispute calls for legal help

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

  • You've been found mostly at fault
  • The whole claim has been refused
  • You were driving for work and the insurer has refused on that basis
  • You've missed the review deadline

You may not need one

  • You mainly want to complain about delays or communication
  • The insurer asked for a document you can easily provide
  • Your doctor can clearly answer the insurer's question in a report

Many disputes turn on medical evidence. If you need a clear report on your diagnosis, or an up-to-date Certificate of Fitness, we can point you to doctors and allied health familiar with CTP claims.

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 Revesby North is the better fit. CTP lawyer in Revesby North
  • 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 Revesby North
  • 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 Revesby North

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

Disputing a threshold-injury decision

A threshold decision limits statutory benefits to 52 weeks for accidents from 1 April 2023, and it rules out a damages claim. A threshold injury is generally soft tissue, and it doesn't include nerve damage or a full or partial tear of a tendon, ligament, meniscus or cartilage. If your medical evidence shows one of those, the classification may be wrong.

Read next:Threshold injury disputesWhen the insurer says “threshold injury”

Making your internal review count

A good review request is short and specific. Quote the decision and its date. Explain in plain terms where you think the insurer got it wrong, with reference to the evidence. If there's something the insurer didn't have, such as a specialist report, include it. Keep a copy and note when you sent it.

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 of Fitness 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

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?

Frequently asked questions

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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.

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