NSW CTP – Requesting an Internal Review of an Insurer’s Decision

Jessica Cheung

Head of NSW Workers' Compensation | Sydney

Time for requesting an internal review

The Motor Accidents Guideline issued by SIRA states that a claimant has 28 days from the notice of a decision to request an internal review from the insurer. If the request is made after 28 days, the insurer may accept or decline the application and must notify the claimant of their decision in writing. If the insurer declines to conduct an internal review, the claimant may refer the dispute to the Personal Injury Commission for assessment.

Application requirements

The Guidelines four methods by which a claimant may request an internal review from the insurer:

a) Completing an application form and delivering it by post, email, facsimile, in person;

b) Completing an online application;

c) Contacting the insurer by letter; or

d) Contacting the insurer by telephone.

The Guidelines specifies that a request for an internal review must include all required information as outlined in the approved paper or online application form. This includes details of the original decision, the alternative decision sought, the issues under review, the reasons for the request, and any additional relevant documentation.

The Guidelines allow a claimant to withdraw a request for an internal review at any time before the insurer sends notification of the internal review decision. The insurer must confirm the withdrawal in writing to the claimant.

Responding to an internal review application

Upon receipt of the application for internal review, the insurer is required to acknowledge receipt by notifying the claimant within two business days. The notification must be in writing and can be delivered via post, email, online electronic delivery, or a combination of these methods based on the claimant’s preference.

The insurer’s notification must indicate whether they accept or decline the application for internal review, and the notification should also include the dates the application was received and the expected date of the internal review decision.

If the insurer accepts the application for internal review, they must inform the claimant of the issues under review, the assigned internal reviewer, additional information required from the claimant, and how to contact the insurer and the advisory service.

However, if the insurer declines the application, they must provide the claimant with brief reasons for their decision, the name of the internal reviewer who made the decision, how to contact the insurer and the advisory service, and the options available to the claimant if they disagree with the decision. The claimant can apply to the Personal Injury Commission to dispute a reviewable decision of the insurer if the insurer declines to conduct an internal review.

If the insurer accepts the application but later decides it cannot conduct the internal review, they must notify the claimant in writing within seven days of their decision to decline the application.

The internal review decision

The internal reviewer is responsible for assessing the internal review application in its entirety and making their decision based on the evidence presented, including relevant factual and legal information.

When evaluating an internal review application, the internal reviewer has the authority to either:

a) Affirm the original decision (i.e. uphold the original decision);

b) Vary the original decision; or

c) Set aside the original decision and make a decision in substitution for the original decision.

As per section 7.9(4) of the Motor Accident Injuries Act 2017, the insurer is required to inform the claimant of the outcome of the internal review within 14 days, unless the Guidelines allow for an extended timeframe under specific circumstances.

The CTP scheme is a complex one and if you have sustained injuries (physical and/or psychological injuries) from a motor vehicle accident, we highly recommend you seek legal advice. The Head of our NSW team, Jessica Cheung is an Accredited Specialist in Personal Injury Law. Depending on your claim, we can review the liability notice on your behalf, request for an extension of time to lodge internal review, obtain medical evidence to support your injuries and position, and then challenge the insurer’s decision on your behalf.

If you believe you have sustained a personal injury and would like professional legal advice, reach out to Jessica and her team for a confidential discussion at no costs to you.

*The intention and purpose of this article is to be used as a guide only.