Internal review (NSW CTP)
If a NSW CTP insurer makes a decision you disagree with (for example liability, weekly payments, capacity for work, or treatment approvals), the first formal step is often an internal review. This is the insurer reconsidering its decision through a reviewer who was not involved in the original determination.
General information only — the right pathway depends on your decision letter.
1) What an internal review is (high level)
An internal review is meant to provide a fair second look at the decision and correct mistakes. You typically provide a short submission and any new evidence (especially evidence that directly answers the insurer’s reasons).
2) Common decisions people review
- Liability decisions (fault / mostly at fault)
- Weekly payments reduced or stopped
- Treatment refused (“reasonable and necessary” disputes)
- Capacity for work decisions
- Threshold injury classifications
Related: CTP claim disputes hub.
3) Time limits and practical approach
Time limits can be strict. The safest approach is to treat the decision date as urgent and get advice immediately.
- Request the decision in writing (if you don’t have it).
- Identify the exact decision type and date.
- Gather targeted evidence answering the insurer’s reasons.
4) If the insurer doesn’t change its decision
If the decision is affirmed, the next step is commonly the NSW Personal Injury Commission (PIC). The correct PIC pathway depends on whether the dispute is administrative/factual (merit review) or medical (medical assessment).
Frequently asked questions
- Is an internal review required before going to the PIC?
- Often yes, but it depends on the decision type and dispute category. Getting advice early can prevent delays from filing in the wrong category.
- How long do I have to request an internal review?
- Time limits commonly apply (often 28 days) from the date you receive the insurer decision. The correct deadline depends on the decision type.
- What evidence should I include?
- Targeted evidence addressing the insurer’s written reasons (for example a treating report for treatment disputes, or financial records for PIWE).