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 Whitebridge understand the decision, the deadlines and whether an independent lawyer would help.
Newcastle & the Hunter · CTP claim denied
CTP claim denied? Help for people in Whitebridge
Internal review first, then the Personal Injury Commission. Check your options free, by phone or online.
Postcode: 2290
- Free claim check, no obligation
- By phone & online, no office to visit
- Helping people in Whitebridge & Dudley
Challenging a decision from Whitebridge
Crashes on the New England Highway or around the Port of Newcastle can involve heavy vehicles, and sometimes more than one insurer. If a decision about fault has gone against you, the review window is generally 28 days from receiving it. There's no need to get to Newcastle, or anywhere else, to dispute a decision. From Whitebridge, 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. Your review rights don't depend on your council, whether that's Lake Macquarie City Council or any other. Internal reviews and the Personal Injury Commission work the same way across NSW.
- Region
- Newcastle & the Hunter
- Postcode
- 2290
- Distance to Newcastle
- ~7 km
- Local government area
- Lake Macquarie City Council
A refusal isn't the end of the road
Insurers make decisions under the scheme rules: whether to accept a claim, how much to pay, what treatment to fund, whether an injury is threshold. Most of them can be challenged. The first step is an internal review, which you generally need to request within 28 days of the decision reaching you. If that doesn't resolve it, the Personal Injury Commission can decide.
Read next:CTP claim denied?
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 It replaced the older dispute bodies, so older material that sends you elsewhere is out of date.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
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.
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
Check your review options, free
A free, no-obligation claim check by phone or online. We'll look at the decision and the deadline, and connect you with an independent lawyer if needed.
Common reasons a claim is refused or limited
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 treatment request may be declined. Each raises its own evidence questions, and each can generally be reviewed.
- The claim was lodged late
- 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
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.
Medical and threshold disputes
A threshold decision about a psychological injury can be disputed like any other. If the insurer has classified yours as threshold and your treating practitioner disagrees, their written opinion 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”
What a dispute might cost
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
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 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
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
- A medical assessment certificate seems wrong
- The refusal is based on your claim being late
- You were driving for work and the insurer has refused on that basis
- You've missed the review deadline
You may not need one
- Your doctor can clearly answer the insurer's question in a report
- The insurer asked for a document you can easily provide
- You agree with the decision once it's explained
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 Whitebridge
- When the real argument is how serious your injury is, the injury compensation page for Whitebridge covers impairment and the threshold line. Injury compensation lawyer in Whitebridge
- If you haven't had a decision yet and are still getting the claim in, start with the CTP claims page for Whitebridge. CTP claims in Whitebridge
Frequently asked questions
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.
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. Evidence from your treating doctor or specialist is usually central to 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.
Generally yes. If your dispute went to medical assessment at the Personal Injury Commission and you think the certificate is wrong, you can seek a review, but it must generally be sought within 28 days of the certificate being issued. The grounds for a review are generally limited, so it's worth getting advice quickly about whether a review is likely to be accepted.
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 Whitebridge
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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.