CTP weekly payments stopped or reduced in NSW

A weekly-payment decision can look simple because the practical result is one thing: money stopped or reduced. Legally and evidentially, the reason matters. Do not assume the insurer has made a calculation error before identifying the reason relied on. A review about the wrong issue can waste the review window.

Under the current NSW scheme, weekly-payment formulas change across entitlement periods. In the first 13 weeks, section 3.6 of the Motor Accident Injuries Act 2017 uses a 95% framework applied to the difference between PAWE and post-accident earning capacity or post-accident earnings, using the greater of those post-accident figures where relevant. In weeks 14 to 78, section 3.7 uses 80% for total loss and 85% for partial loss concepts. Section 3.8 deals with payments after week 78, where earning-capacity comparisons become central. Maximum weekly statutory benefit caps can apply.

Payments can also cease or be limited by statutory rules. Current issues include the 52-week rule for people determined to be wholly or mostly at fault or whose only injuries are threshold injuries, maximum weekly-payment periods, retirement-age rules and suspensions for not providing required medical evidence, certificates or authorisations.

Older accident dates may involve different rules. The current Motor Accident Guidelines require written notice before weekly payments are discontinued or reduced, including reasons, internal review information and PIC rights where applicable. Always check the accident date, the current decision notice and the section or guideline paragraph the insurer relies on. A PAWE correction can affect the amount, but it does not automatically answer capacity, post-accident earnings or cessation issues.

If the dispute is about stopped or reduced payments in an existing claim, start with the decision notice. If the issue is that the weekly-payment claim was lodged late or incompletely, check the claim lodgement date as a separate issue.

Under the current SIRA Motor Accident Guidelines, a statutory benefits claim is generally made within three months after the accident. Lodging within 28 days is important if the claimant seeks weekly payments from the day after the accident. A late claim or missing police event details may need a separate explanation and evidence. Do not confuse that timing issue with PAWE arithmetic or medical work capacity.

CTP weekly payments deal with personal injury income support. They do not cover ordinary vehicle repairs or other property damage.

A PAWE issue asks: what was your correct pre-accident earning figure? A capacity issue asks: what can you now do after the accident? A post-accident earnings issue asks: what are you actually earning, or what does the insurer say you can earn?

For PAWE, use earnings documents. For capacity, use medical and vocational evidence. For post-accident earnings, use current pay and work-trial evidence. If the same letter mentions all three, prepare a short issue table with separate headings so the reviewer can see which evidence belongs to which decision.

These examples concern PAWE and payment amount. If the insurer says you can work more, use capacity evidence as well; earnings records alone will not answer a medical work-capacity decision.

Capacity evidence should address sustainable work, not just diagnosis. Useful material can include current certificates of capacity, treating doctor reports, specialist restrictions, rehabilitation notes, actual job duties, failed upgrades, travel tolerance, medication side effects and employer evidence about available duties.

If the insurer relies on an IME or vocational report, answer the specific assumptions: hours, duties, breaks, lifting, sitting/standing tolerance, concentration, flare-ups and whether the proposed work is realistically available with your restrictions.

Warning: this example is simplified and not a calculator. Your position depends on the accident date, decision reasons, PAWE, capacity, current earnings, caps, certificates and statutory cessation rules.

Suppose the insurer calculates PAWE at $1,200 and originally pays a weekly amount using the first entitlement period. Later, the insurer says the person can return to suitable work earning $700 per week. The dispute is not just whether PAWE is $1,200. The claimant must also answer the capacity assumption and the post-accident earning figure.

A focused response might attach the PAWE worksheet, corrected wage evidence, current payslips showing actual earnings of only $250 per week, a treating report explaining restrictions, and employer correspondence showing no suitable duties are available. Those documents answer different parts of the decision.

1. Read the notice: identify the reason, decision date, review deadline and material relied on.
2. Ask for missing documents: request the PAWE worksheet, IME report, vocational report, certificate gap or calculation sheet if not provided.
3. Prepare a bucketed response: separate PAWE, capacity, current earnings and cessation issues.
4. Lodge before the deadline: use the deadline in the notice. If evidence is incomplete, lodge a core review and identify supplementary material.
5. Escalate if unresolved: unresolved issues may proceed to the Personal Injury Commission, but the correct pathway depends on whether the issue is merit, medical or another dispute type.

Send the insurer decision notice, review deadline, PAWE worksheet, recent payment history, certificates of capacity, IME or vocational report, wage records before and after the accident, employer correspondence, tax/business records if relevant and a short chronology of work attempts.

If you are asking for legal help, also send the document that shows the deadline. The first task is to preserve the review pathway, then improve the evidence.