Personal Injury Commission (PIC): merit review vs medical assessment
If you’ve exhausted an insurer internal review (or the scheme allows you to proceed), NSW CTP disputes are often determined through the NSW Personal Injury Commission (PIC). The PIC has different pathways depending on the type of dispute.
General information only — the correct pathway depends on your decision letter.
1) What the PIC does (high level)
The PIC is an independent body that resolves disputes between claimants and insurers in NSW personal injury schemes. In CTP matters, PIC determinations commonly affect weekly payments, treatment approvals, injury classifications and more.
See also: PIC hub page.
2) What a merit review usually covers
- Administrative / factual decisions (e.g. earnings calculations in some contexts)
- Capacity-for-work / vocational issues (depending on the exact decision)
- Benefit suspensions for alleged non-compliance (depending on category)
Merit review is usually about documents, factual material and how the insurer applied the rules.
3) What a medical assessment usually covers
- Threshold injury classification disputes
- Treatment disputes (reasonable and necessary)
- WPI disputes (technical impairment assessments)
Medical assessment disputes often turn on high-quality treating evidence, specialist reports and consistency over time.
4) Evidence tips (what usually matters)
- Start with the insurer reasons — address them directly.
- Use targeted evidence — financial records for earnings issues; treating/specialist evidence for medical disputes.
- Be consistent — the history across records matters.
Frequently asked questions
- Can one claim involve both a merit review and a medical assessment?
- Yes. A single motor accident can involve multiple disputes (for example capacity/earnings issues and also treatment disputes). Each dispute must be filed in the correct category.
- Is the PIC decision binding?
- PIC certificates are generally binding for the dispute decided, subject to limited review/appeal pathways depending on the decision type.
- What is the biggest mistake people make?
- Filing in the wrong category and not addressing the insurer’s reasons with targeted evidence.