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 cease payments for several specific legal and medical reasons under the Motor Accident Injuries Act 2017. 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).
1) 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.
2) 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.
3) 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.
4) 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: You generally have 28 days to request an Internal Review.
- 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.