A letter refusing your CTP claim can feel final. It usually isn't. Most insurer decisions can be challenged, first by internal review and then at the Personal Injury Commission. If you live in Taren Point and the insurer has said no, our free claim check looks at the decision and its deadlines, and connects you with an independent CTP lawyer if a dispute is worth pursuing. Some aren't, and we'll tell you.
Sutherland Shire · CTP claim denied
Denied CTP claim in Taren Point: the review path
The insurer's decision is rarely the last word. The first deadline is generally 28 days, so start now.
Postcode: 2229
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Challenging a decision from Taren Point
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. Coming under Sutherland Shire Council makes no difference to a CTP dispute. The same review steps and deadlines apply in Taren Point as in any other part of NSW, because the scheme is statewide. At around 19 km from the Sydney CBD, living in Taren 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
- Sutherland Shire
- Postcode
- 2229
- Local government area
- Sutherland Shire Council
- Distance to Hurstville
- ~6 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?
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.
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.
If the review confirms the original decision, that isn't the end. You can generally take most disputes to the Personal Injury Commission. If the review changes the decision, check the new letter carefully to make sure it covers everything you raised, and ask about anything it leaves out.
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
Free claim check
Don't let the 28 days slip by
The claim check is free and carries no obligation. Tell us what the insurer decided, and we'll point you to the right help.
When the argument is about your injury
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”
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
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
Legal costs in a dispute
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?
Your review path
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
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
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 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
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
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.
When a dispute calls for legal help
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
- The refusal is based on your claim being late
- A medical assessment certificate seems wrong
- The whole claim has been refused
- You've been found mostly at fault
You may not need one
- The insurer asked for a document you can easily provide
- The decision was about a small, one-off expense
- You mainly want to complain about delays or communication
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 Taren Point is the better fit. CTP lawyer in Taren Point
- When the real argument is how serious your injury is, the injury compensation page for Taren Point covers impairment and the threshold line. Injury compensation lawyer in Taren Point
- 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 Taren Point
Frequently asked questions
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.
Usually 14 days from your request. Some medical and miscellaneous matters give the insurer 21 days, and it can take up to 28 days where it needs more information from you. If you haven't heard within those times, follow up in writing. If the delay itself is the problem, you can also complain to the Independent Review Office.
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.
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.
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.
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.
CTP claim denied: suburbs near Taren 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.