CTP Dispute Lawyer NSW

A letter from the insurer saying no can feel final. Usually it isn't. Most insurer decisions in the NSW CTP scheme come with review rights, and the first step is generally an internal review, where the insurer reconsiders its own decision. If that doesn't resolve it, many disputes can go to the Personal Injury Commission (PIC), an independent tribunal.

Each step has its own time limits and forms. The decision letter should tell you what you can do and by when. Read it closely and keep it.

Decisions people commonly dispute

• Liability denied: the insurer says the accident isn't covered, or that you're not entitled to benefits.
• Fault: a finding that you were mostly at fault (contributory negligence greater than 61%), which generally limits benefits to 52 weeks and rules out damages.
• Threshold injury: a decision that your injury is a threshold injury, which generally limits benefits to 52 weeks and rules out damages.
• Weekly payments: the amount, the pre-accident earnings used, or a decision to reduce or stop them.
• Treatment and care: a request refused as not reasonable and necessary, or as not related to the accident.
• Late claims: a claim rejected because it was lodged after a deadline, or a refusal to back-pay weekly payments because the explanation for the delay wasn't accepted.
• Whole person impairment: an assessment of 10% or less when you believe it's higher, which affects damages for pain and suffering.

How the dispute pathway generally works

• Read the decision and its reasons, and note any deadline for asking for a review.
• Internal review: ask the insurer in writing to reconsider, generally within 28 days of receiving the decision, and provide new evidence that answers its reasons, such as a report from your treating doctor. The insurer usually has 14 days to decide (21 days for some medical and miscellaneous matters, up to 28 days if it needs more information).
• Personal Injury Commission: if internal review doesn't resolve it, many disputes can go to the PIC, an independent tribunal that has decided CTP disputes since 1 March 2021. Depending on the issue, it may be decided by a merit reviewer, a medical assessor or a member of the Commission. A review of a medical assessment certificate must generally be sought within 28 days of the certificate being issued.
• Damages disputes: disagreements about a damages claim, such as its value, are generally resolved by negotiation or through claims assessment at the PIC. Court proceedings are possible only in limited circumstances.

What a CTP dispute lawyer typically does

• Reads the decision against the scheme rules and tells you whether it's worth challenging.
• Meets the review deadlines and prepares the internal review application.
• Gathers the evidence that answers the insurer's reasons: medical reports, earnings records and witness statements.
• Prepares and runs the PIC application, including preparing you for any medical assessment.
• Keeps your other entitlements running while the dispute continues, where that's possible.
• Advises whether a dispute, a damages claim or a settlement is the better path.

Do you actually need a lawyer?

Not for every dispute. You can ask for an internal review yourself, the decision letter should explain how, and CTP Assist (1300 656 919) can talk you through the process. A specialist lawyer tends to matter more when the dispute is heading to the Personal Injury Commission, affects whether you can claim damages, or turns on complex evidence.

Many disputes, especially about threshold injuries and refused treatment, turn on the medical evidence. If you need a clear report or an up-to-date Certificate of Fitness from a treating doctor, we can point you to doctors experienced with CTP claims and allied health.

Questions to ask a dispute lawyer

• What's the deadline for challenging this decision?
• What evidence would the insurer or the PIC need to see to change it?
• Does this decision affect whether I can claim damages?
• How are costs handled for a dispute, and can I have that in writing?

Costs

Our claim check is free, with no obligation. Legal costs in CTP statutory benefits disputes are tightly regulated: they can only be recovered where the Regulation or the Personal Injury Commission allows it, in which case the insurer pays them, and for some disputes they can't be recovered at all. Ask any lawyer how that applies to your dispute, and get a written costs disclosure before you sign.

SIRA also funds a free CTP Legal Advisory Service for statutory benefits questions (accidents from 1 December 2017). It doesn't cover damages claims, or matters already at internal review or the Personal Injury Commission, which is often the point where people look for a specialist lawyer.