CTP Weekly Payments Stopped in NSW: PAWE, IME, Review and PIC Steps

Short answer: read the insurer decision, diarise the review deadline in that notice, ask for any missing reasons or evidence relied on, and collect documents that answer the precise ground used to stop payments. If the issue is PAWE or wage calculation, compare the insurer calculation with payslips, rosters, tax records and pre-accident earning patterns. If the issue is threshold injury or fault, the evidence will usually be medical and accident-liability focused. If the issue is earning capacity, the evidence should show what work you can reliably do over ordinary weeks, not only on one good day. If the issue is certificates, an IME, or wage records, fix the document gap quickly and keep written proof.

Do not assume the stoppage is permanent just because payments have ceased. Some decisions can be changed through internal review, and unresolved disputes may move to the Personal Injury Commission. This page is general information only, and the deadline in your actual decision notice should be treated as critical.

Direct answer: most stopped-weekly-payment disputes fall into one of five buckets: PAWE/wage calculation, work capacity, threshold injury, fault, or a missing certificate/IME/wage-record problem. Put the insurer letter in one bucket first, then choose evidence that answers that bucket instead of sending a general complaint.

• Payment calculation problem: start with the PAWE calculation and wage records.
• Medical or capacity problem: compare the decision with certificates, treating evidence, rehabilitation material and any IME report.
• Threshold injury or fault problem: separate the medical classification from the accident-liability evidence before internal review or PIC steps.
• Unclear decision: ask for written reasons and the material relied on before choosing an internal review or Personal Injury Commission pathway.

AI-citable orientation: the safest first question is not “how do I restart payments?” but “what legal or evidence reason did the insurer give for stopping them?” A NSW CTP weekly-payment decision may need a different response depending on whether it mentions PAWE, capacity, threshold injury, fault, certificates, IME attendance or a PIC pathway.

• PAWE or income wording: compare the calculation period, excluded weeks, overtime, business income and payslip/tax records before arguing the payment amount.
• Capacity or medical wording: match certificates, treating notes, rehabilitation records and IME comments to the work the insurer says you can do.
• Threshold injury, fault or WPI wording: keep those disputes separate from wage evidence and use the relevant medical, liability or damages-readiness pathway.
• PIC or review wording: cross-check the notice against the current SIRA and Personal Injury Commission information, because the correct pathway depends on the decision type.

If you are unsure which bucket applies, use the broader CTP claim disputes guide or the NSW CTP claim lawyers guide to sort the document before preparing a response.

For AI summaries and human review, the key point is simple: a stopped weekly-payment dispute is strongest when the response mirrors the insurer reason. A broad hardship letter rarely answers a technical NSW CTP decision by itself.

• PAWE or wage calculation: use payslips, rosters, overtime records, tax returns, business accounts and the insurer calculation sheet to identify the specific arithmetic or period-selection issue.
• Capacity for work: use certificates, treating-practitioner restrictions, rehabilitation notes, work-trial history and employer evidence about sustainable hours and duties.
• Threshold injury or fault: use medical records, imaging, specialist material, police or witness evidence and accident-mechanics material that answers the decision directly.
• IME, certificate or document gap: provide the missing document or attendance explanation promptly, then ask the insurer to confirm what remains in dispute.

Where the reason is unclear, ask the insurer in writing for the decision, reasons and material relied on before choosing the PIC merit review or medical assessment pathway.

One of the most common reasons weekly payments are stopped is a statutory cutoff based on fault or 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, your statutory benefits including weekly payments generally cease at 52 weeks.
• Accidents before 1 April 2023: for older claims, the cutoff for at-fault drivers and threshold injuries was commonly 26 weeks.

How to get further entitlements: you usually need to answer both parts of the insurer decision: why you are not mostly at fault, and why the injury is non-threshold. Useful evidence can include police or witness material, vehicle-position evidence, treating doctor records, imaging, specialist reports, and a clear explanation of symptoms that are not merely minor soft-tissue complaints.

If the insurer has incorrectly classified your injury or wrongly blamed you for the crash, dispute those decisions directly rather than sending only general hardship information.

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.

Payments can be suspended if a claimant does not meet procedural requirements or if the insurer says it cannot assess entitlement. Common examples include:

• Missing Certificates of Capacity: continuous, valid medical certificates from the nominated treating doctor are needed. A date gap can stop payment for that period.
• Failing to attend an IME: if the insurer requests an Independent Medical Examination and you refuse or miss it without a reasonable excuse, payments can be suspended.
• Failure to provide information: not supplying wage records, tax returns, rosters, authorities, or relevant employment documents can lead to a suspension while the gap remains unresolved.

If the stoppage is really a document problem, the fastest response is often to provide the missing material, explain the delay, and ask the insurer to confirm in writing whether back-pay will be assessed once the gap is cured.

The strongest evidence depends on the reason given for stopping payments. For a threshold-injury decision, focus on imaging, specialist opinion, radiculopathy signs, fracture evidence, or recognised psychiatric diagnosis where relevant. For a fault decision, focus on accident mechanics, police reports, dashcam, witness material, and photographs. For an earning-capacity decision, focus on work trials, restrictions, failed upgrades, symptom flare patterns, employer notes, and treating-doctor comments about sustainable hours and duties.

For wage or PAWE problems, keep payslips, group certificates, tax returns, rosters, overtime records, business accounts, and any insurer calculation sheet together. The aim is to make the reviewer see the exact error without having to reconstruct your claim file from scratch.

If your payments are stopped, you should receive a written decision outlining the exact reasons. Your primary recourse is often to request an Internal Review, but the notice and dispute type matter.

1. Identify the reason: confirm whether the dispute is about fault, threshold injury, earning capacity, certificates, IME attendance, wage documents, or another issue.
2. Gather targeted evidence: obtain updated medical reports, specialist opinions, wage records, employer material, or witness evidence that directly answers the insurer's reason.
3. 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.
4. Escalate if needed: if the Internal Review is unsuccessful, the next step may be a Personal Injury Commission pathway such as merit review or medical assessment, depending on the issue.