Late review requests require the correct stream
What if I miss a CTP internal-review deadline?
Act immediately: a late request may still be lodged, but acceptance and the next step depend on the decision type
For decisions that proceed through merit review, current PIC guidance says an internal-review request made within 28 days of receiving the insurer decision must be accepted. A request can be made later, but the insurer does not have to accept it. A merit-review application made more than 28 days after the internal-review decision may also be declined by the Commission. Medical and miscellaneous disputes have different rules and prerequisites. Send the decision, proof of receipt, reason for delay and complete supporting material promptly; do not assume a complaint or correspondence preserves the review right.
The phrase “internal-review deadline” can refer to different insurer decisions. PAWE and some weekly-payment calculations commonly enter the merit-review stream. Treatment, causation, threshold injury and WPI can enter medical assessment, while fault and other listed matters may enter miscellaneous claims assessment. The correct response cannot be chosen from the deadline alone.
A late explanation should be factual, supported and tied to the period of delay. It should not replace the substantive case. The application must still identify the decision sought, issues and evidence. Urgent advice is appropriate because contacting a lawyer does not stop time running.
Reviewed by Herman Chan, Stephen Young Lawyers
Which decision and review stream apply?
Read the insurer letter, its statutory reference and review information. Separate merit matters such as PAWE from medical matters such as treatment or threshold injury and miscellaneous matters such as fault. One letter can contain more than one decision and therefore more than one process.
Do not file a generic objection under every heading. Identify the alternative decision sought for each issue and use the current insurer or Commission process that has authority to decide it.
What should a late explanation contain?
State when the decision was received, when it was understood, what prevented an earlier application, what occurred throughout the delay and when action was taken. Attach objective support where available, such as hospital admission, incapacity, access or delivery records, interpreter issues or correspondence showing a genuine attempt to obtain the decision or reasons.
Avoid exaggeration and unexplained gaps. A good explanation does not guarantee acceptance, but a vague statement such as “I was busy” gives the decision-maker little basis to assess the delay. Include the substantive evidence at the same time unless the process permits and justifies later material.
Can the matter still go to PIC?
That depends on the dispute. Current PIC merit-review guidance allows an application to be made at any time but says the Commission does not have to accept one made more than 28 days after the claimant receives the insurer’s internal-review decision. Medical disputes generally require internal review first except for specified circumstances, including permanent-impairment decisions, while their lodgment and review rules differ.
Some miscellaneous assessment matters can be referred under their own statutory rules. A late insurer review, a late Commission application and a panel-review application are separate procedural questions. Check the current Act, Regulation, Rules, Guidelines and procedural direction for the exact decision.
Practical next steps
What to do after discovering a missed date
Build the chronology and correct application immediately rather than continuing informal correspondence.
Secure the complete decision
Keep the letter, attachments, envelope, email headers and proof of the date it was received.
Classify each issue
Identify whether it is merit, medical, miscellaneous, damages or another matter and whether internal review is required.
Write the delay chronology
Explain the whole period accurately and attach available supporting evidence.
Prepare the substantive case
State the replacement decision sought and provide the medical, earnings or factual material that answers the insurer’s reasons.
Lodge through the verified channel
Use the insurer or Pathway process applicable to that stream and keep the receipt.
Evidence
Late-review evidence checklist
The file must prove both timing and the merits of the requested change.
- Insurer decision and every attachment.
- Email headers, portal record, envelope or other receipt evidence.
- Chronology covering the entire period of delay.
- Documents supporting the reason for delay.
- Internal-review request and insurer acceptance or refusal.
- Alternative decision and issue-by-issue submissions.
- Medical, earnings or factual evidence answering the decision.
- Pathway or insurer lodgment receipt.
Late-review mistakes to avoid
- Do not assume the insurer must accept every request made after 28 days.
- Do not assume a complaint about service replaces internal review or a PIC application.
- Do not use the merit-review timing rule for every medical or miscellaneous dispute.
- Do not submit only an explanation for delay and omit the evidence on the actual dispute.
- Do not wait for informal negotiations if a separate Commission or court period may be running.
Timing
The 28-day significance must be tied to the decision
Current PIC guidance provides clear 28-day markers for merit review, but other streams require separate checking.
- For a merit-reviewable insurer decision, a claimant request for internal review made within 28 days of receipt must be accepted under current PIC guidance.
- A later internal-review request can be made, but the insurer does not have to accept it.
- A merit-review application more than 28 days after receipt of the internal-review decision may be declined by the Commission.
- Medical review panels, further assessments, miscellaneous claims and court proceedings have different triggers; contacting a lawyer does not extend them.
Frequently asked questions
- Is my CTP dispute over if I missed 28 days?
- Not necessarily. A late request may still be made, but acceptance and the available next process depend on the decision and evidence. Act urgently.
- What is a good reason for delay?
- There is no guaranteed category. Give a truthful chronology and objective support for the entire delay, then address the merits of the dispute.
- Can I lodge at PIC without internal review?
- It depends on the dispute. Most merit matters and many medical matters require internal review first, while specified exceptions and other streams have different rules.
- Does emailing the claims officer count as a review request?
- Do not assume so. Use the approved or clearly verified process, identify the decision and alternative outcome, and keep proof of lodgment.
- Can a complaint extend the deadline?
- No general rule says it does. A complaint is not a substitute for the statutory review or PIC process.
- Should I wait for more medical evidence before lodging?
- Protect the procedural date first using the applicable process. Include the available core evidence and explain any genuinely outstanding material rather than allowing further delay.
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
- SIRA Motor Accident Guidelines, current published version
- Personal Injury Commission: merit review disputes
- Personal Injury Commission: medical disputes
- Personal Injury Commission: miscellaneous claims assessment
- Personal Injury Commission Procedural Direction MA2: merit review
- Personal Injury Commission: current procedural directions
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.
Urgent decision review
Have you discovered a missed CTP review date?
Send the complete decision, date received, review correspondence and a short delay chronology. We can identify the correct stream and the evidence needed without promising acceptance.
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.