Reasons and supporting material
How can I obtain the evidence the CTP insurer relied on?
Start with the written decision and request each identified document that you do not already have
A proper insurer decision should explain the issue and identify the evidence supporting it. The Motor Accident Guidelines impose specific disclosure requirements for several decisions. Ask for the complete decision, its list of relevant material and copies not previously supplied. Do not ask only for “the whole file”: identify the decision, report, surveillance, wage calculation or other item needed to understand and challenge the reason.
Claimants often receive a conclusion such as “treatment is not reasonable and necessary” or “you have capacity for work” without immediately recognising which report, record or calculation produced it. The response should begin by mapping each reason to the supporting document. That makes an internal review or PIC application more focused and reduces the risk of answering an issue the insurer did not actually decide.
Disclosure rules vary with the decision and claim stream. A liability notice, weekly-payment reduction, treatment refusal, damages liability decision and internal-review decision each have different requirements. Privilege and sensitive third-party material can also affect access. The safest page-level guidance is therefore to identify the applicable notice and current clause rather than promise an unrestricted copy of every internal note.
Reviewed by Herman Chan, Stephen Young Lawyers
What should the decision notice contain?
For a statutory-benefits liability decision, Guidelines clauses 4.33-4.39 require a written explanation and consequences. Where liability is denied in whole or part, the notice must list all relevant information, whether or not it supports the decision, and attach material not already provided or supplied by the claimant. New information relevant to liability must also be copied to the claimant as soon as practicable.
A weekly-payment discontinuance or reduction notice must state reasons, explain review rights and provide the information relied on. Treatment refusals should identify clinical reasons and, where further information is required, say what is missing and give a reasonable opportunity to provide it. A damages liability notice under clauses 4.125-4.126 must identify evidence, review rights and list relevant material.
How should I frame the request?
Quote the decision date, claim number and exact issue. List the documents referred to by name or description: independent medical report, surveillance footage and report, vocational assessment, Certificate of Fitness, wage schedule, PAWE worksheet, witness statement, repair material or internal-review material. Ask for legible copies and the date each item was received or considered.
If the insurer says a document was already supplied, ask when and by what channel. If a report is incomplete because attachments, questions to the examiner or source records are missing, identify those components. Do not delay the substantive response where the deadline is close; lodge the available core material and explain what has been requested where the applicable procedure permits.
How should the evidence be used in a review or dispute?
Create an issue table with the insurer reason, relied-on evidence, factual or medical problem, your response and the supporting document. A disagreement should explain why the evidence does not support the conclusion, not simply assert that the insurer is wrong. For example, identify a missing wage period, a medical history omitted from an IME report or surveillance that does not address certified restrictions.
Internal-review procedures permit the insurer to reasonably request further information and require the claimant to be given an opportunity to respond to relevant information. In a PIC merit review, the insurer may be required to give the claimant and reviewer its statement of reasons and supporting material if requested by the reviewer. The exact filing and evidence rules depend on the dispute type.
Practical next steps
A document-led response
Build the review around the stated reason and the actual evidence.
Identify the decision
Record the date, legal issue, outcome, effective date and stated review rights.
Make a relied-on evidence list
Extract every report, record, calculation and factual allegation mentioned in the reasons.
Request missing copies
Ask for each item specifically and refer to the applicable disclosure requirement where known.
Check completeness and context
Compare the report with its referral questions, source records and attachments. Record what is absent or factually wrong.
Respond issue by issue
Use the correct internal-review or PIC process and provide evidence that addresses the insurer's precise reason.
Evidence
Material commonly requested
The relevant bundle depends on the decision, but these categories often matter.
- Complete written insurer decision and review-rights notice.
- List of all relevant information identified in the notice.
- Independent medical report, referral letter and questions asked.
- Surveillance video, stills and investigator report relied on.
- Vocational or rehabilitation assessment.
- PAWE calculation, earnings schedule and source payroll records.
- Treatment request, clinical material and insurer medical review.
- Witness statements, police or vehicle evidence relied on for fault.
- Internal-review application, additional material and review decision.
Do not confuse disclosure with outcome
- Receiving a report does not make the insurer decision correct or incorrect; the reasoning still requires analysis.
- An insurer may hold material that was not relevant to the particular decision. A request should remain focused.
- Internal file notes may raise privilege or other restrictions; do not promise that every note must be produced.
- Do not wait for perfect disclosure while allowing a review period to expire.
- Do not send a generic objection that fails to address the stated medical, earnings or liability reason.
Timing
Protect the review period while seeking documents
A document request does not ordinarily stop time.
- Read the review notice immediately and calculate the period from the relevant decision and current procedure.
- Request missing evidence promptly and keep proof of the request.
- Where a deadline is close, obtain advice about lodging the core review or PIC application and later material rather than assuming an extension.
- If the insurer produces new information, record when it was received and seek a fair opportunity to respond under the applicable process.
Frequently asked questions
- Can I ask for the insurer's entire file?
- You can ask, but there is no safe general promise that every internal document must be provided. A targeted request tied to a decision and the Guidelines is usually more effective.
- Should I receive the IME report?
- If the insurer relies on it for a decision, request the complete report and associated referral questions. Specific Guidelines also require relevant relied-on material with particular notices.
- Can I obtain surveillance footage?
- Request the footage and report where the decision refers to or relies on surveillance. The timing, privacy and procedural handling may depend on the claim and dispute stage.
- What if the insurer gives only a summary?
- Ask for the complete identified document, including attachments, and explain why the summary does not allow the reason to be tested.
- Does asking for evidence extend internal review time?
- Do not assume so. Continue to protect the period stated in the decision and obtain advice about the applicable current rule.
- Can a PIC Member order documents?
- The Commission has production powers under the PIC Act and Rules. The appropriate mechanism depends on who holds the document, relevance, existing entitlements and the proceedings.
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
- Personal Injury Commission Act 2020 (NSW), current in-force version
- Personal Injury Commission Rules 2021 (NSW), current in-force version
- 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. The correct response depends on the accident date, the type of claim, the insurer communication and the evidence already supplied.
Decision evidence
Have the reasons and relied-on material matched before filing a dispute
Send the complete decision, evidence list and missing-document correspondence. We can identify the review issue and the material that actually answers it.
General information only: This page explains the current NSW motor accidents scheme in general terms and is not legal advice. It does not guarantee claim acceptance, continued benefits, a review outcome or damages. Keep acting on any stated time limit while obtaining advice.