When you have been injured in a car accident and cannot work, your weekly payments are often the only thing keeping the household running. So when the CTP insurer suddenly reduces or stops those payments, it can feel like the ground has been pulled out from under you, usually at the exact moment you can least afford it.
The important thing to understand is this. If your CTP insurer has stopped your weekly payments, that decision is not necessarily correct, and it is not necessarily the end of your income support. Insurers make these decisions on paper, and they do not always get them right. There is a clear process for challenging them, and strict time limits that make acting quickly essential.
This guide explains how weekly payments work under the New South Wales CTP scheme, the reasons an insurer might stop them, how long they are meant to last, and the exact steps to take to have the decision reviewed. Please treat this as general information rather than advice about your own claim. Every matter turns on its own medical evidence, insurer decisions and deadlines.
Understanding weekly payments under the NSW CTP scheme
Weekly payments, sometimes called income support, are part of the statutory benefits available under the Motor Accident Injuries Act 2017 (NSW), the law that governs motor accidents in this state on or after 1 December 2017. The scheme is regulated by the State Insurance Regulatory Authority, known as SIRA, and the payments come from the compulsory third party, or green slip, insurer of the vehicle at fault.
These payments are designed to replace a portion of the income you have lost because your injuries have left you unable to work, or able to work only in a reduced way. One key point catches many people out. Weekly payments are only available to an earner, which broadly means someone who was working, or had arranged to work, around the time of the accident. If the insurer decides you do not meet the definition of an earner, or disputes how much you were earning, that alone can affect your payments.
It is also worth knowing that statutory benefits are separate from a claim for damages. Weekly payments help you in the short to medium term while you recover, whereas a common law damages claim deals with the longer term financial cost of a more serious injury. The two are connected, and as you will see below, the damages claim can become important if your weekly payments are approaching a cut off.
Why has my CTP insurer stopped my weekly payments?
If your CTP insurer has stopped your weekly payments, the law requires them to tell you the reason in writing. Once you understand the reason, you can work out whether it can be challenged. In practice, the most common reasons we see include the following.
You have reached the end of an entitlement period. Weekly payments are not open ended. They are structured around set periods after the accident, and continuing beyond each stage depends on fault and the seriousness of your injuries. Reaching one of these limits is the most frequent reason payments stop.
The insurer says you have capacity to return to work. Insurers often rely on their own medical assessments to decide that you are fit for some form of work, even where your treating doctor disagrees. A decision like this can reduce or end your payments even though you do not feel ready to return.
Your injuries have been classified as threshold injuries. The scheme treats less serious injuries, previously called minor injuries and now called threshold injuries, differently. If all of your injuries are assessed as threshold injuries, your benefits are generally limited to the first period only.
The insurer has decided you were wholly or mostly at fault. Being at fault does not shut you out of the scheme entirely, and you can still receive benefits for an initial period. Beyond that period, however, being wholly or mostly at fault will generally bring weekly payments to an end.
Your Certificate of Fitness has lapsed. Weekly payments depend on current medical evidence of your incapacity. If your Certificate of Fitness expires, or a gap appears, or it does not list all of your injuries, the insurer may suspend payments until the paperwork is brought up to date.
There is a dispute about your earnings or your capacity. Disagreements about your pre accident weekly earnings, or about how much you can now earn, can lead the insurer to recalculate or stop what it pays you.
Consider a realistic example. A delivery driver is off work with a back injury and receiving weekly payments. The insurer arranges its own medical examination, which concludes she has capacity for lighter duties, and it reduces her payments accordingly. Her own GP has certified that she remains unfit for her role. That kind of conflict between medical opinions is exactly the situation that can be challenged with the right evidence. This example is illustrative only and every claim depends on its own facts.
How long weekly payments last: the entitlement periods
Understanding the entitlement periods helps explain why payments stop when they do. The scheme sets out stages after your accident, and whether you keep receiving income support at each stage depends on fault and injury severity. The table below sets out the general position for accidents on or after 1 April 2023.
| Period after the accident | Who can generally receive weekly income support | Key requirements |
|---|---|---|
| First 52 weeks | Most injured earners, regardless of fault | You are an earner and are unfit or only partly fit for work |
| 52 to 78 weeks | People not mostly at fault with more than threshold injuries | Injuries assessed above the threshold and an ongoing loss of earning capacity |
| 78 weeks to 2 years | The same group, under stricter tests | Your continued incapacity is assessed under the later period rules |
| Beyond 2 years, up to 5 years | The same group, with a damages claim on foot | A pending common law claim for damages, with longer support where impairment is above 10 per cent |
A few things are worth drawing out. For accidents before 1 April 2023, the first period was 26 weeks rather than 52 weeks, so if your payments stopped at around six months, the date of your accident matters. If all of your injuries are threshold injuries, or you were wholly or mostly at fault, your benefits generally stop at the end of that first period. To keep receiving income support beyond two years, you usually need a common law damages claim underway, which is one reason it is important to get advice well before you reach that point rather than after. Treatment and care benefits follow separate rules and can continue for much longer, in serious cases for life.
What to do when your CTP insurer stops your weekly payments
The worst response to a stopped payment is to accept it without question or to let the deadlines slide. There is a defined process for challenging the decision, and each stage is a fresh opportunity to have it changed. Here is how to approach it.
- Read the decision letter carefully and identify the exact reason your payments were stopped.
- Make sure your Certificate of Fitness is current and lists every injury, including psychological effects, medication side effects and any earlier condition the accident has made worse.
- Gather medical evidence that supports your ongoing incapacity or shows that your injuries are more than threshold injuries.
- Request an internal review by the insurer, in writing, within 28 days of the decision.
- If you are not satisfied with the internal review, take the dispute to the Personal Injury Commission.
- Get legal advice early, ideally before you lodge the review, so the strongest case is put from the start.
The two formal stages, internal review and the Personal Injury Commission, are worth explaining in more detail.
Requesting an internal review
Your first formal step is usually to ask the insurer to conduct an internal review, sometimes called an insurer internal review. You must apply within 28 days of receiving the decision. A different person inside the insurer, who was not involved in the original decision, then reconsiders it, taking into account any new information you provide. The insurer must acknowledge your application within a couple of working days and generally give you an outcome within 14 days, although that can extend if further information is needed. This stage costs you nothing and can resolve matters quickly, particularly where you supply fresh medical evidence that was not before the original decision maker.
Taking the dispute to the Personal Injury Commission
If the internal review does not resolve things, or you do not receive a decision within 28 days, you can take the dispute to the Personal Injury Commission. The Commission is an independent tribunal that resolves disputes between injured people and insurers under the CTP scheme, and it took over these functions from earlier dispute bodies in 2021. Depending on the issue, your dispute may be handled as a merit review, a medical assessment or a claims assessment. The Commission can look afresh at questions such as your work capacity, whether your injuries are above the threshold, and how your entitlements have been calculated, and its determination is binding on the insurer.
Time limits you cannot afford to miss
Time limits are one of the most important and least understood parts of this process, and missing one can seriously affect your rights.
To have weekly payments backdated to the date of your accident, your claim generally needs to be lodged within 28 days, and there is usually a final window of three months to lodge at all, with a satisfactory explanation for any delay. If your payments have already been stopped, you have 28 days from the insurer’s decision to request an internal review. Strict time limits, commonly 28 days from the internal review decision, then apply to taking the matter to the Personal Injury Commission. And if your injuries are serious enough to support a common law claim for damages, court proceedings generally must be commenced within three years of the accident.
The practical message is simple. Do not wait. The sooner you act, the more options remain open, and the easier it is to keep your income support flowing while the dispute is resolved.
Getting income support beyond two years
If your injuries are more serious, the point at which weekly payments would otherwise stop is often the point at which a common law damages claim becomes important. To continue receiving income support beyond two years, you generally need a claim for damages underway, and you must not have been wholly or mostly at fault and must have injuries assessed above the threshold.
A damages claim is also where the longer term financial cost of a serious injury is addressed, including past and future loss of earnings. If your weekly payments are being cut off and you have lasting injuries, it is worth having your position assessed to see whether a damages claim is open to you, because the timing of that claim can directly affect whether your income support continues.
Where free and funded help is available
There is genuine support available, and you should not feel you have to face the insurer alone. SIRA runs a service called CTP Assist that can answer general questions and point you in the right direction. For many CTP disputes, legal costs are regulated and paid by the insurer rather than by you, which means you can often be represented at little or no cost. There is also a funded CTP Legal Advisory Service for certain disputes, and the Independent Review Office can help if you have a complaint about how an insurer is handling your claim.
None of this replaces having an experienced personal injury lawyer in your corner when the issues are complex or the insurer is being difficult, but it does mean that cost should not stop you from getting advice about a stopped payment.
How Stephen Young Lawyers can help
A decision to stop your weekly payments is not a fight you should have to take on while you are recovering and worrying about money. An experienced personal injury lawyer levels the field. We review the insurer’s decision and the reasons behind it, make sure your medical evidence properly reflects your injuries and your capacity, and manage the dispute through internal review and the Personal Injury Commission where needed. Where your injuries are serious, we can also advise on whether a common law damages claim should be started to protect your longer term entitlements.
Because motor accident injuries often overlap with other claims, we can also tell you whether you have a related entitlement. If your accident happened while you were working or travelling for work, you may also have a workers compensation claim running alongside your motor vehicle accident claim. If your injuries have permanently affected your ability to work, you may also have a Total and Permanent Disability claim through your superannuation. As an Accredited Specialist personal injury firm based in Sydney CBD, with a multilingual team and a No Win No Fee approach for eligible matters, we can review where your claim stands and what the next step should be.
A stopped payment is a decision, not a verdict. With the right evidence and the right guidance, it can be challenged.
Speak with an experienced CTP lawyer today
If your CTP insurer has stopped your weekly payments anywhere in New South Wales, do not accept the decision as final and do not let the 28 day review deadline pass. The sooner your position is reviewed, the better your chances of restoring your income support.
Contact Stephen Young Lawyers today for a free, no obligation consultation. Call us or get in touch through our website to speak with an experienced personal injury lawyer about your situation and the options available to you.