Dispute resolution under the SIRA Motor Accident Guidelines
The State Insurance Regulatory Authority (SIRA) Motor Accident Guidelines set out strict rules for how NSW CTP claims and disputes must be handled. Part 7 of these Guidelines specifically governs the dispute resolution process, including how insurers must conduct internal reviews and how matters interact with the Personal Injury Commission (PIC). This page provides a general overview of these requirements.
1) The purpose of the dispute resolution guidelines
Part 7 of the Guidelines supports the administration of the CTP scheme by establishing clear processes for dispute resolution. It aims to ensure that disputes are resolved as quickly, fairly, and cost-effectively as possible.
Before a dispute reaches the PIC, the Guidelines usually require the insurer to undertake a formal internal review of their original decision to see if the dispute can be resolved early.
2) Insurer internal review requirements
When a claimant requests an internal review, the insurer is bound by the Guidelines to respond within specific timeframes (commonly acknowledging the request within two business days). The Guidelines state that the review must be conducted by someone with the appropriate skills and experience, and crucially, the reviewer must not have been involved in making or advising on the initial decision.
During the review, the insurer must consider any new information provided. The Guidelines set out strict maximum periods for completing the review (often 14 to 21 days depending on the dispute type, though extensions can apply if new information is requested).
3) Notification of the internal review decision
The Guidelines require insurers to notify the claimant of the outcome of an internal review in writing. This notice must clearly state the reviewer’s decision, the reasons for that decision (with reference to the evidence relied upon), and the consequences of the decision on the claimant’s entitlements.
Importantly, the insurer must also provide information about the claimant’s right to lodge a dispute with the Personal Injury Commission if they remain dissatisfied.
4) Escalating to the Personal Injury Commission (PIC)
If the internal review does not resolve the issue, or if the insurer fails to complete the review within the required timeframe, the Guidelines and the Act provide pathways to escalate the dispute to the PIC. The PIC handles various matters including merit reviews and medical assessments.
Read more about the PIC pathways here: Merit review vs medical assessment.
Frequently asked questions
- Do the Guidelines force insurers to do an internal review?
- Yes, for many types of decisions, Part 7 of the Guidelines mandates that an insurer must conduct an internal review if requested properly and within time.
- Who conducts the internal review?
- The Guidelines stipulate that the internal reviewer must be someone who was not involved in making or advising on the initial decision.
- How long does an internal review take?
- The Guidelines set out specific timeframes, often 14 to 21 days, depending on the type of medical or merit dispute, though the provision of new information can extend these periods.
- What if the insurer ignores my internal review request?
- If an insurer fails to complete an internal review within the timeframe required by the Guidelines, you generally have the right to escalate the dispute directly to the Personal Injury Commission.