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 Tennyson, 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.
Hawkesbury · CTP claim denied
Denied CTP claim in Tennyson: the review path
Internal review first, then the Personal Injury Commission. Check your options free, by phone or online.
Postcode: 2754
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Tennyson: reviews without the travel
Riders on Bells Line of Road or Putty Road who came off alone may find benefits limited because of fault. If you disagree with a fault finding, you can generally ask for an internal review. People in Tennyson, within Hawkesbury City 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. Tennyson is about 11 km north-west of Windsor, 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
- Hawkesbury
- Postcode
- 2754
- Local government area
- Hawkesbury City Council
- Distance to Windsor
- ~11 km
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?
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: an updated report, payslips, photos or witness details.
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 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
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”
Free claim check
Don't let the 28 days slip by
No office visit and no charge for the check. A quick claim check by phone or online tells you whether a review is worth pursuing.
Taking a dispute further
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 decisions behind many disputes
Some decisions come up again and again. A claim may be refused because it was lodged late, or limited because the insurer says the injury is threshold or that you were mostly at fault. Weekly payments may stop, or a request for treatment and care may be declined. Each raises its own evidence questions, and each can generally be reviewed.
- The claim was lodged late
- The injury was classed as a threshold injury
- A treatment and care request was declined
- The insurer says the injury wasn't caused by the crash
Read next:Claim denied? Quick check
When your issue is how you were treated
CTP Assist and the IRO are different services with different roles. CTP Assist, on 1300 656 919, gives information and support about claims. The IRO, on 13 94 76, handles complaints about how CTP insurers behave. Neither decides disputes about your entitlements; that's the job of internal review and the Personal Injury Commission.
Legal costs in a dispute
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?
Your review path
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
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
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.
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
- The whole claim has been refused
- You've missed the review deadline
- You've been found mostly at fault
You may not need one
- A request was declined only because some information was missing
- You agree with the decision once it's explained
- The decision was about a small, one-off expense
For statutory benefits disputes on accidents from 1 December 2017, SIRA's free CTP Legal Advisory Service can help before internal review starts. CTP Assist on 1300 656 919 can connect you with it. The Personal Injury Commission
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 Tennyson
- If the dispute turns on whether your injury is more than threshold, the injury compensation page explains what the evidence needs to show. Injury compensation lawyer in Tennyson
- If you haven't had a decision yet and are still getting the claim in, start with the CTP claims page for Tennyson. CTP claims in Tennyson
Frequently asked questions
Not necessarily, but act now. Some decisions may still be open to challenge, and the rules can depend on the type of decision and your circumstances. Speak to a lawyer as soon as you can, and gather anything that explains the delay, such as not receiving the letter or being unable to manage your affairs. Don't assume the door is closed without checking.
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.
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.
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.
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.
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 Tennyson
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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.