NSW CTP Claim
NSW CTP Claim
Your expert in CTP claims

The Internal Review Process: Challenging an Insurer’s Decision

If you disagree with a decision made by a CTP insurer—such as declining treatment or stopping your payments—the first step in the dispute resolution process is usually an Internal Review. This allows the insurer to correct errors and reconsider evidence before the matter is escalated to the tribunal. General information only.

Key references on this page

1) What is an Internal Review?

An Internal Review is a formal reconsideration of a claim decision. It is mandatory for most types of CTP disputes before you are allowed to apply to the Personal Injury Commission.

It is conducted by an independent reviewer who works for the insurer but had no prior involvement in your claim.

2) How to request a review

  1. Identify the Decision: Clearly state which decision you are disputing (e.g., the letter dated [Date]).
  2. Provide Reasons: Explain why you believe the original decision was wrong, referencing the facts of your accident and injury.
  3. New Evidence: This is the most important part. Provide a new doctor’s report, financial records, or witness statements that support your case.

3) Possible outcomes

The Internal Review can have three results:

  • Affirm: The original decision is upheld (not changed).
  • Vary: The decision is partially changed in your favor.
  • Overturn: The original decision is completely reversed in your favor.

4) What if I’m still unhappy?

If the Internal Review does not resolve the dispute to your satisfaction, you have the right to escalate the matter to the Personal Injury Commission (PIC) for an independent determination by a tribunal Member or Assessor.

Frequently asked questions

How long do I have to request an Internal Review?
You generally have 28 days from the date you receive the insurer’s original decision to lodge your review request. Missing this deadline can jeopardize your right to dispute the decision.
How long does the insurer have to respond?
Once a valid Internal Review request is submitted, the insurer typically has 14 days to conduct the review and issue a new decision.
Is the internal reviewer the same person who made the decision?
No. The review must be conducted by an independent person within the insurance company who was not involved in making the original determination.