Relevant records, consent and claim cooperation
Do I have to sign a medical authority giving the insurer my records?
Read the authority carefully and ask what relevant records the insurer needs
A CTP insurer needs relevant medical information to assess the accident injury, treatment, work capacity and other claim issues. The approved claim process includes authorities and information obligations, but you should not sign an unclear or blank release without understanding its scope. Check which providers, record period, purpose and information are covered, keep a copy and obtain advice if the request appears unrelated or excessively broad. Simply refusing all records can delay or prejudice assessment of the claim.
Medical history can be relevant where the insurer examines accident causation, a pre-existing condition, work capacity, treatment need, threshold injury or WPI. Relevance does not mean every record from every provider necessarily answers the disputed issue.
A transparent process identifies the decision being made, records sought and reason. It also maintains an audit trail of what was authorised, obtained and relied on.
Reviewed by Herman Chan, Stephen Young Lawyers
What should you check before signing?
Read the names of recipients and providers, the date range, categories of records, duration of authority, revocation process and stated purpose. Guideline 4.100 requires authority for treating practitioners to provide relevant information for a recovery plan; Guideline 4.107 allows the claimant to revoke that authority by notifying the insurer and to request copies of relevant treatment decisions and correspondence with the treating practitioner. Those provisions do not make every unlimited authority reasonable.
Keep the signed version, not only the blank template. If the insurer changes the authority or asks for a new one, compare the versions and request an explanation for any broader scope.
Why can pre-accident records be relevant?
Prior records may show baseline symptoms, treatment, work capacity, medication or imaging. They can support an aggravation as well as an insurer’s alternative-causation argument. Hiding a prior condition can create a credibility issue; disclosing it accurately allows the medical evidence to explain what changed.
The insurer should still connect the records sought to a live claim issue. If it requests remote or sensitive history with no apparent connection, ask it to identify the relevance rather than sending argumentative correspondence or refusing cooperation without advice.
What if the records contain errors or sensitive information?
Do not alter records. If a factual entry is wrong, ask the provider about its formal correction or addendum process and retain both the original and transparent correction. A claimant can also provide a concise explanation supported by other records.
Sensitive information should be handled through secure accepted channels. Avoid emailing unencrypted identity documents or complete medical files to an unfamiliar address. Ask who will receive the records and use the insurer’s verified contact details or portal.
Practical next steps
A careful medical-authority process
Cooperate with relevant evidence requests while keeping the scope and audit trail clear.
Identify the decision being assessed
Ask whether the records concern causation, treatment, capacity, threshold injury, WPI or another issue.
Read every field
Check providers, dates, record types, recipients, duration and revocation terms before signing.
Clarify excessive or unclear scope
Ask in writing how the requested material is relevant and whether identified records can be supplied instead.
Keep the executed authority
Retain the exact signed document and all correspondence about its use.
Review the resulting decision
Ask for the records or reports relied on where appropriate and address any factual error through evidence.
Evidence
Medical-authority checklist
Keep enough information to know what was requested, authorised, obtained and used.
- Complete authority form before signature.
- Insurer letter explaining the records and claim issue.
- List of named providers and date range.
- Copy of the signed and dated authority.
- Secure submission receipt or portal confirmation.
- Provider correspondence and records supplied where available.
- Any correction, addendum or claimant explanation of an inaccurate entry.
- Insurer decision and evidence identified in its reasons.
What to avoid
- Do not sign a blank authority or one with undefined providers and dates without clarification.
- Do not assume all pre-accident records are harmful; they may establish a genuine baseline and aggravation.
- Do not refuse every request without considering claim cooperation and the insurer’s need for relevant evidence.
- Do not alter an original medical record or ask a provider to rewrite history.
- Do not send sensitive records through an unverified address or public form.
Timing
Response and decision timing
An authority request can delay assessment if it is ignored, but it does not replace a formal insurer decision.
- Respond within any reasonable date stated or ask promptly for clarification or an extension.
- Keep the underlying claim within the general three-month statutory benefits period.
- If the insurer says further information is needed before deciding treatment, Guideline 4.106 requires it to identify the missing material and give a reasonable opportunity to provide it.
- Ask the insurer to confirm whether the missing authority is preventing a treatment or payment decision.
- If an adverse decision follows, check its specific review rights and triggering date rather than treating the authority request itself as the decision.
Frequently asked questions
- Can the insurer see my entire medical history?
- Relevant prior history may be required, but scope should connect to a claim issue. Read the authority and ask the insurer to explain an apparently unrelated or unlimited request.
- Can I send records instead of signing?
- Sometimes identified records may address the issue, but do not assume that replaces the scheme’s information or authority requirements. Confirm the arrangement in writing.
- What if a prior condition is private?
- Privacy and relevance should be handled carefully, but a relevant prior condition should not be concealed. Obtain advice about an appropriately scoped response.
- Can I revoke an authority?
- Check the terms and current legal position. Revocation may affect the insurer’s ability to assess the claim, so obtain advice before acting.
- Can the insurer use records for an IME?
- Relevant records may be provided to an examiner. Check the examination purpose, questions and material being considered.
- What if the insurer misreads an old record?
- Identify the exact passage, provide surrounding records and obtain a reasoned treating explanation rather than simply alleging unfairness.
Related NSW CTP guides
Official sources
- Motor Accident Injuries Act 2017 (NSW), current in-force version
- SIRA Motor Accident Guidelines, current published version
- SIRA Motor Accident Guidelines Part 4: claims
- SIRA: fees and approval for motor crash health services
- Personal Injury Commission: medical disputes
Assessment source: Motor Accident Injuries Act 2017 (NSW), section 3.24 and the current SIRA Motor Accident Guidelines Part 4. The insurer must apply the statutory test and current Guidelines to the individual treatment, recovery or causation issue.
Scope and relevance review
Has the insurer requested a broad medical authority?
Send the blank authority and covering letter before signing. We can identify the live claim issue, scope and evidence request without advising a blanket refusal.
General information only: This page is general NSW CTP information, not legal or medical advice. It does not promise approval, reimbursement, a particular provider or a dispute outcome. Urgent medical care should not be delayed while waiting for legal advice.