What can I do if the insurer has not completed its internal review on time?

The Guidelines require the insurer to acknowledge an internal-review request within two business days. If it accepts the review, it should identify the issues, reviewer, further information and due date as soon as practicable and within seven days. The internal reviewer must be independent of the original decision in the way specified by clause 7.15.

Clause 7.24 sets a general 14-day notification period. Table 7.1 gives 21 days for specified permanent impairment, threshold injury, fault, mostly-at-fault, serious driving offence and contributory-negligence matters. If the claimant provides relevant new information after requesting review, the period can be 14 days after that material is provided. Clause 7.26 caps the total period at 28 days from the request.

Use calendar dates and retain the document that triggered each date. Record when the insurer received the request, whether it requested further material, when that material was supplied and the date stated in its acknowledgement. An informal phone call that does not identify the decision, alternative result and reasons may create an argument about whether a valid review request was made.

Send a short written status request. Attach the original review request and delivery proof, state the calculated due date and ask whether a decision has been issued. Do not repeatedly send argumentative emails or continually restart the evidence bundle. The purpose is to establish the record and obtain any missing certificate or reasons.

Prepare the PIC material at the same time: original decision, review request, acknowledgement, chronology, evidence and a clear statement of the alternative decision sought. If weekly payments or treatment are being affected, also keep the current payment schedule, Certificates of Fitness and treatment requests. Delay in the review does not remove the need to prove the substantive issue.

A SIRA complaint may address administration or insurer conduct, but it is not a substitute for a statutory PIC application that determines the disputed decision. Choose the route by the legal issue, not by which organisation answered first.

For merit review, Guidelines clause 7.34 says that where internal review was required but not completed on time, the PIC application period runs for 28 days after the date the insurer was required to complete the review. That is a specific rule for merit review; it should not be presented as the deadline for every medical or miscellaneous dispute.

The current PIC Rules permit a medical assessment application about an insurer decision as soon as practicable after the internal-review outcome, a refusal to conduct review, or the date by which the insurer should have completed it. A claims assessment or miscellaneous application follows the Act, Rules, approved form and MA7. Check the classification before lodging, because the wrong stream can delay the case and fail to answer the insurer decision.

If the insurer issues the review while the application is being prepared, use the review certificate and reasons. If a PIC matter has already been lodged, provide the new decision through the Commission process and comply with directions about amendment or additional documents rather than emailing the decision-maker directly.