Review rights depend on the decision type
Can an insurer challenge or change a PIC decision?
Some PIC decisions have a statutory panel or further-assessment process; others require a different and narrower route
There is no single appeal process for every PIC motor accident decision. Either party may seek review of a medical assessment on the statutory ground and within the process set out for medical review panels. A claimant may seek merit review, and current PIC guidance provides a panel-review process for a single merit-review decision. Medical matters may also have further-assessment or obvious-error mechanisms in specified circumstances. Miscellaneous and damages decisions have different statutory effects. Court judicial review is a specialist supervisory process, not a general rehearing on the merits.
The first line of any PIC certificate should be classified before advice is given. A Medical Assessor, Merit Reviewer, Member or claims assessor performs a different statutory function. The fact that one party dislikes the result does not reveal which review, correction or court process exists.
The insurer and claimant may both have rights in some streams, but not identical rights in all streams. Each process has its own standing, grounds, evidence, timing and outcome. Preserve the certificate, reasons and date sent before making further submissions.
Reviewed by Herman Chan, Stephen Young Lawyers
How can a medical assessment be reviewed or revisited?
PIC7 states that either party may apply for a medical assessment by a single Medical Assessor to be referred to a review panel on the statutory ground that the decision was incorrect in a material respect. The application ordinarily must be made within 28 days after the original medical certificate was issued, with the current extension rule applying to late applications.
The Act and PIC procedures also identify further medical assessment in specified circumstances, such as deterioration or additional relevant information capable of materially affecting the outcome, and correction of an obvious error. Those mechanisms are not substitutes for simply repeating the original case and do not guarantee a new assessment.
What happens after a merit-review decision?
Current PIC guidance provides a panel-review application after a single merit-review decision. The application must identify why the decision is incorrect in a material respect and ordinarily be made within 28 days of the date the decision was sent. The President determines whether the statutory review threshold is met.
A review panel considers the correct and preferable decision on the material before it and may confirm or set aside the earlier decision and substitute another. This process is distinct from medical review and from an insurer’s ordinary internal review.
What about Member decisions, damages assessments and court review?
Miscellaneous claims and damages assessments have statutory effects and procedures that differ from medical and merit certificates. MA7 explains, for example, how an assessment of damages may be accepted and when it binds the insurer under the Act. The exact certificate and section must be read before describing finality or enforcement.
Judicial review in the Supreme Court concerns jurisdictional or legal error and is governed by court law and procedure. It is not an opportunity to ask the Court to choose a preferred factual outcome merely because a party disagrees. Urgent specialist advice is required before any court step.
Practical next steps
What to do when a PIC decision may be challenged
Classify the decision, preserve the issue and check the exact statutory route immediately.
Keep the full certificate and reasons
Download the decision, attachments, email or Pathway notice and date sent.
Identify the decision-maker
Determine whether it is a Medical Assessor, Merit Reviewer, review panel, Member or claims assessment.
Identify the permitted ground
Separate material error, further medical evidence, obvious error, statutory acceptance or a possible court-law issue.
Map new and existing evidence
Explain precisely what was before the decision-maker and why later material can lawfully be considered.
Use the correct application
Follow PIC7, MA2, MA7, another current direction or obtain court advice as applicable.
Evidence
PIC-decision review checklist
A review application should address the statutory decision and ground, not merely repeat dissatisfaction.
- Complete PIC certificate and statement of reasons.
- Date the decision was sent and proof of receipt.
- Original application, reply, submissions and evidence bundle.
- Directions, conference record and any agreed issues.
- Proposed review ground linked to the legislation or procedural direction.
- New medical or factual evidence with dates and explanation of relevance.
- Draft alternative decision or relief sought.
- Any insurer action taken or withheld after the decision.
Review language to use carefully
- Do not call every PIC challenge an appeal; review, further assessment, correction and judicial review are different.
- Disagreement with the outcome alone does not establish material error or a court-review ground.
- Do not use the 28-day medical-review rule for every Member or damages decision.
- New evidence is not automatically admissible or sufficient; explain the statutory basis and material effect.
- Do not assume an application suspends the decision or insurer obligations unless the governing process says so.
Timing
The decision date and stream control urgency
Several review processes use short periods, but they do not share one universal trigger.
- PIC7 states that a medical-review application ordinarily must be made within 28 days after the medical certificate is issued, subject to the current extension rule.
- Current PIC merit-review guidance states that a panel-review application must be made within 28 days of the date the decision was sent.
- Further medical assessment, correction, miscellaneous/damages processes and judicial review have different requirements and must be checked separately.
- Requesting reasons, negotiating or contacting a lawyer does not itself extend the applicable period.
Frequently asked questions
- Can the insurer review a Medical Assessor’s decision?
- Either party may apply for referral to a medical review panel on the statutory ground that the assessment was incorrect in a material respect, subject to the current timing and acceptance rules.
- Can an insurer seek merit panel review?
- The statutory standing and process must be checked for the particular decision. Current PIC public guidance describes a panel-review process following a single merit review and requires a material-error explanation.
- Can PIC correct a typo in a certificate?
- PIC7 includes an obvious-error correction process. A clerical correction is different from changing the substantive merits.
- Can new deterioration lead to another medical assessment?
- A further medical assessment may be available in specified circumstances where deterioration or additional relevant information is capable of materially affecting the outcome. It is not automatic.
- Can the Supreme Court reconsider all the evidence?
- Judicial review is supervisory and generally concerns legal or jurisdictional error, not a general merits rehearing. Specialist court advice is required.
- Must the insurer follow a PIC decision while considering review?
- The certificate, statute, any stay or direction and the particular review process must be checked. Do not assume a review request automatically suspends every obligation.
Related NSW CTP guides
Official sources
- Motor Accident Injuries Act 2017 (NSW), current in-force version
- Motor Accident Injuries Regulation 2017 (NSW), current in-force version
- Personal Injury Commission: NSW motor accident disputes
- Personal Injury Commission: merit review disputes
- Personal Injury Commission: medical disputes
- Personal Injury Commission Procedural Direction PIC7: medical reviews and corrections
- Personal Injury Commission Procedural Direction MA2: merit review
- Personal Injury Commission Procedural Direction MA7: claims disputes
The legislation and official guidance linked above are the public-source basis for this page. Settlement, recovery and review consequences depend on the particular claim, documents and current law.
PIC decision review
Has the insurer or another party challenged a PIC decision?
Send the complete certificate, reasons, date sent and proposed review document. We can identify the decision type, available process and evidence without promising that a review will be accepted or succeed.
General information only: This page provides general NSW CTP information, not legal, financial, tax, Medicare, Centrelink or judicial-review advice. It does not determine an individual entitlement, guarantee acceptance of a late application or extend any deadline.