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 Waverley 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.
Eastern Suburbs · CTP claim denied
CTP claim rejected? Review options for Waverley
Insurers make decisions under the scheme rules. You can challenge them, and an independent lawyer can help.
Postcode: 2024
- Free claim check, no obligation
- By phone & online, no office to visit
- Helping people in Waverley & Charing Cross
What a review looks like from Waverley
If Prince of Wales Hospital or St Vincent's Hospital records support your case, include them with your review request. Fresh medical evidence can be what changes a decision on review. At around 5 km from the Sydney CBD, living in Waverley 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. People in Waverley, within Waverley 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
- Eastern Suburbs
- Postcode
- 2024
- From the Sydney CBD
- ~5 km
- Local government area
- Waverley Council
Most decisions can be challenged
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 Personal Injury Commission
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
How to request a review
Reviews are often decided on the papers, so what you send matters. If the decision was about your injury, ask your treating doctor to explain their findings in writing. 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 of Fitness if you're off work, and keep a record of every contact about the review.
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
Check your review options, free
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.
Disputing a threshold-injury decision
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”
Complaints versus disputes
It helps to keep a dispute and a complaint apart. If the problem is the outcome, use internal review and then the Personal Injury Commission. If the problem is the way the insurer is handling your claim, the Independent Review Office can take a complaint. Sometimes both apply, and it's fine to use each path for a different part of the problem.
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 injury was classed as a threshold injury
- A treatment 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
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?
From decision letter to the Commission
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.
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
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 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
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.
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.
Reviewing alone or with 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
- Weekly payments were stopped and you can't work
- The whole claim has been refused
- A medical assessment certificate seems wrong
- You've missed the review deadline
You may not need one
- The decision was about a small, one-off expense
- A treatment request was declined for lack of information you can supply
- Your doctor can clearly answer the insurer's question in a report
When treatment is declined, the fix is often a clearer explanation of why it's needed. We can connect you with doctors and allied health who know how the scheme assesses requests and what a Certificate of Fitness should record.
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 Waverley
- When the real argument is how serious your injury is, the injury compensation page for Waverley covers impairment and the threshold line. Injury compensation lawyer in Waverley
- If you haven't had a decision yet and are still getting the claim in, start with the CTP claims page for Waverley. CTP claims in Waverley
Frequently asked questions
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. Evidence from your treating doctor or specialist is usually central to the outcome.
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.
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 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.
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.
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.
CTP claim denied: suburbs near Waverley
Ready to talk it through?
Get a free, no-obligation claim check. It's the first step toward understanding where your claim stands and what help it needs.
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.