Weekly Payments Stopped: Why It Happens and How to Dispute It
A decision by a CTP insurer to reduce or stop your weekly income support payments can cause immediate financial stress. Insurers can stop payments for several specific legal and medical reasons under the Motor Accident Injuries Act 2017. If it is not the statutory 52/26 week cutoff, the 78-week earning-capacity review is often the second decision point. Understanding exactly why your payments were stopped is the first step in deciding how to challenge the decision through an Internal Review or the Personal Injury Commission (PIC).
Quick answer
A decision by a CTP insurer to reduce or stop your weekly income support payments can cause immediate financial stress. Insurers can stop payments for several specific legal and medical reasons under the Motor Accident Injuries Act 2017. If it is not the statutory 52/26 week cutoff, the 78-week earning-capacity review is often the second decision point. Understanding exactly why your payments were stopped is the first step in deciding how to challenge the decision through an Internal Review or the Personal Injury Commission (PIC).
Why this guide is structured this way
This page is written to help NSW CTP claimants understand deadlines, evidence, insurer decisions, and dispute pathways in plain language without overstating outcomes.
General information only. Your position depends on your facts, evidence, insurer response, and applicable time limits.
Official legal frame and public sources
These links are not a substitute for advice, but they are the main public-source anchors behind many NSW CTP questions on this page.
Top questions answered
Will my payments be backdated if I win the dispute?
Yes, if the Personal Injury Commission or the Internal Review overturns the insurer's decision, you are generally entitled to back-pay for the period your payments were wrongfully suspended.
Can I claim damages if my weeklies stop at 52 weeks?
If your weeklies stopped because you have a threshold injury or were mostly at fault, you are generally not eligible for common law damages. You must successfully dispute the threshold/fault decision to open the damages pathway.
Do I need a lawyer to dispute stopped payments?
Disputes involving fault, non-threshold injuries, and earning capacity at 78 weeks are highly technical and rely heavily on legal and medical interpretation. Having legal representation is strongly advised to navigate the PIC process.
At-Fault or Threshold Injury Cutoffs (52 Weeks / 26 Weeks)
One of the most common reasons weekly payments are stopped is due to statutory time limits based on fault and injury classification.
- Accidents on or after 1 April 2023: If the insurer determines that you were wholly or mostly at fault for the accident, OR that your injuries are strictly threshold injuries (e.g., minor soft tissue injuries), your statutory benefits (including weekly payments) will cease at 52 weeks.
- Accidents before 1 April 2023: For older claims, the cutoff for at-fault drivers and threshold injuries is 26 weeks.
How to get further entitlements: To continue receiving weekly wages beyond these cutoffs, you must successfully prove two things:
1. You are not mostly at fault for the accident.
2. You have sustained a non-threshold injury (e.g., a fracture, nerve damage, or recognized psychiatric illness).
If the insurer has incorrectly classified your injury or wrongly blamed you for the crash, you must dispute these decisions to restore your payments.
Earning Capacity Decisions (The 78-Week Point)
If you pass the initial fault/threshold hurdles, another major hurdle occurs at the 78-week mark.
Around this time, insurers must make a formal "earning capacity decision." They will review medical reports, vocational assessments, and rehabilitation notes to determine what kind of work you are physically and psychologically capable of doing, even if it is not your pre-injury job.
If the insurer decides you have a current earning capacity that allows you to earn your pre-injury wages (or a significant portion of them), they will reduce or stop your weekly payments. Disputing this requires strong counter-evidence from your treating doctors regarding your actual functional restrictions.
Non-Compliance and Lack of Evidence
Payments can be suspended if you fail to comply with the procedural requirements of the scheme. This includes:
- Missing Certificates of Capacity: You must provide continuous, valid medical certificates from your nominated treating doctor. If there is a gap in dates, the insurer cannot pay you for that period.
- Failing to attend an IME: If the insurer requests you attend an Independent Medical Examination (IME) and you refuse or fail to attend without a reasonable excuse, payments can be suspended.
- Failure to provide information: Not supplying requested wage records, tax returns, or signing authorities can lead to a suspension of benefits.
How to Dispute the Decision
If your payments are stopped, you should receive a written decision outlining the exact reasons. Your primary recourse is to request an Internal Review.
- Identify the reason: Are they disputing fault, injury threshold, or work capacity?
- Gather evidence: Obtain new medical reports, specialist opinions, or witness statements that directly contradict the insurer's reason.
- Lodge the Review: Time limits depend on the decision type and notice wording (28 days is common in many matters, but not universal), so follow the deadline in your letter.
- Escalate to the PIC: If the Internal Review is unsuccessful, you can lodge a dispute with the Personal Injury Commission (PIC) for an independent determination.
Frequently asked questions
- Will my payments be backdated if I win the dispute?
- Yes, if the Personal Injury Commission or the Internal Review overturns the insurer's decision, you are generally entitled to back-pay for the period your payments were wrongfully suspended.
- Can I claim damages if my weeklies stop at 52 weeks?
- If your weeklies stopped because you have a threshold injury or were mostly at fault, you are generally not eligible for common law damages. You must successfully dispute the threshold/fault decision to open the damages pathway.
- Do I need a lawyer to dispute stopped payments?
- Disputes involving fault, non-threshold injuries, and earning capacity at 78 weeks are highly technical and rely heavily on legal and medical interpretation. Having legal representation is strongly advised to navigate the PIC process.
- What evidence is most persuasive in a 78-week earning-capacity review?
- Insurance reviewers typically rely on evidence from vocational assessments, rehabilitation notes, treating doctor functional-restriction reports, and current wage or employment documentation showing what work can realistically be performed on the market.
- The insurer says I worked one short casual shift, so I can earn normally again. Does that automatically end weekly payments?
- Not automatically. A single short shift can show limited tolerance on one day, not reliable earning capacity over weeks. The stronger response is a 4–6 week evidence timeline: hours attempted, symptom flare timing, recovery time, treatment changes, missed follow-up shifts, and treating-doctor comments tying those facts to practical work limits.