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 Tuncurry understand the decision, the deadlines and whether an independent lawyer would help.
Mid North Coast · CTP claim denied
CTP claim rejected? Review options for Tuncurry
The insurer's decision is rarely the last word. The first deadline is generally 28 days, so start now.
Postcode: 2428
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Tuncurry: reviews without the travel
If Port Macquarie Base Hospital or Coffs Harbour Health Campus records support your case, ask for them now, because the internal review window generally closes 28 days after the decision reaches you. There's no need to get to Taree, or anywhere else, to dispute a decision. From Tuncurry, 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. People in Tuncurry, within MidCoast 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
- Mid North Coast
- Postcode
- 2428
- Distance to Taree
- ~30 km
- Local government area
- MidCoast Council
You can ask for a second look
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
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.
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 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
The Personal Injury Commission
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
Free claim check
Check your review options, free
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
Medical disputes often come down to evidence. If the insurer says your injury is threshold, or that treatment isn't reasonable and necessary, the answer is usually a clear report from your treating doctor or specialist explaining the diagnosis and the need. 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”
When your issue is how you were treated
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.
The decisions behind many disputes
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 injury was classed as a threshold injury
- You were found wholly or mostly at fault
- The crash is being treated as a work injury
- A treatment request was declined
Read next:Claim denied? Quick check
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?
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
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 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.
Reviewing alone or with 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
- Your injury was classed as threshold and it affects a damages claim
- You've been found mostly at fault
- You've missed the review deadline
- Weekly payments were stopped and you can't work
You may not need one
- The decision was about a small, one-off expense
- Your doctor can clearly answer the insurer's question in a report
- You mainly want to complain about delays or communication
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 Tuncurry
- 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 Tuncurry
- If you haven't had a decision yet and are still getting the claim in, start with the CTP claims page for Tuncurry. CTP claims in Tuncurry
Frequently asked questions
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.
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.
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 a hospital stay or not receiving the letter. Don't assume the door is closed without checking.
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.
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.
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 Tuncurry
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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.