Insurers make decisions about your claim constantly, and not all of them go your way. They can decide that your payments should stop, that your injury is only a threshold injury, that a treatment you need is not reasonable and necessary, or that the accident was mostly your fault. Any one of those decisions can change what you receive and for how long, and when the letter lands it can feel like the matter has been settled without you.
It has not. Every one of those decisions can be disputed, and the New South Wales scheme is built on the assumption that insurers sometimes get things wrong. There is a structured process for challenging a CTP insurer’s decision, it is free to use, and for many disputes your legal costs are paid by the insurer rather than by you. The one thing you cannot afford to do is let the deadlines slide.
This guide explains which decisions you can dispute, the two stages of the process, how to work out which pathway your dispute belongs in, and the time limits that apply. Please treat it as general information rather than advice about your own claim, because every matter turns on its own facts and evidence.
Which CTP decisions can you dispute?
The scheme is governed by the Motor Accident Injuries Act 2017 (NSW), regulated by the State Insurance Regulatory Authority, known as SIRA, and disputes are decided by the Personal Injury Commission, an independent tribunal that took over these functions in 2021.
Almost any decision that affects your entitlements can be challenged. The decisions people most often dispute include a reduction or cessation of weekly payments, a refusal to approve treatment or care, a decision that your injuries are threshold injuries, a decision about your degree of permanent impairment, a finding that you were wholly or mostly at fault, and disagreements about how much you were earning before the accident.
One thing worth understanding at the outset. Asking for a review does not automatically pause the insurer’s decision. The insurer generally continues acting on its original decision until a new one is made, which is another reason to move quickly rather than waiting to see what happens.
Stage one: request an internal review
Almost every CTP dispute begins the same way, with an internal review by the insurer.
You must request the internal review within 28 days of receiving the decision. If you do, the insurer must accept your application. If you apply later than 28 days, the insurer can accept it, but it does not have to, so this deadline genuinely matters. The request can usually be made using the insurer’s form, online, or in writing.
What happens next is that a different person inside the insurer, someone who had no involvement in the original decision, looks at it afresh. Importantly, they can consider new information, so this is your opportunity to put forward medical evidence, updated certificates or documents that were never before the original decision maker. The reviewer must generally decide within 14 days.
Two practical points are worth knowing. No legal costs are payable at the internal review stage, and when the insurer tells you the outcome it must also explain how to take the matter further, including your right to seek legal advice and how to apply to the Personal Injury Commission.
Many disputes end here, simply because the insurer is finally looking at a complete picture of your injuries. If the review does not resolve things, you move to stage two.
Stage two: take the dispute to the Personal Injury Commission
If you are unhappy with the internal review outcome, if the insurer declines to conduct a review, or if it fails to complete the review within 28 days, you can take the dispute to the Personal Injury Commission.
The Commission is independent of the insurer, its services are free, and you do not have to be legally represented, although you can be. Applications are generally lodged through the Commission’s online platform. The key thing to understand is that the Commission handles different kinds of disputes through different pathways, and the pathway depends on what your dispute is actually about.
The table below sets out the main pathways.
| Type of dispute | What it covers | Who decides it |
|---|---|---|
| Merit review | Entitlements to statutory benefits, such as weekly payments, treatment and care expenses, rehabilitation and vocational training | A merit reviewer appointed by the Commission |
| Medical dispute | Medical questions, including whether your injury is a threshold injury, your degree of permanent impairment, and whether treatment is reasonable and necessary | An independent medical assessor |
| Miscellaneous claims assessment | Questions such as fault, whether the accident was mostly caused by you, which insurer is liable, and claims against the Nominal Defendant | A Commission member |
| Damages assessment | The amount of your common law damages where you and the insurer cannot agree on a settlement | A Commission member |
Most of these disputes require you to have gone through internal review first, so it is rarely worth trying to skip that step. Choosing the correct pathway matters too, because an application in the wrong stream simply delays the outcome. This is one of the more common reasons people seek legal help, and it is a good reason to get advice before you lodge.
If you disagree with the Commission’s outcome, there is often a further right of review. A medical assessment can be referred to a medical review panel, and a merit review can be reviewed by a panel, generally within 28 days of the decision.
The time limits that decide whether you can dispute at all
Time limits do more work in this scheme than almost anything else, and missing one can quietly close a door.
You have 28 days from the insurer’s decision to request an internal review as of right. You then generally have 28 days from the internal review outcome to apply to the Personal Injury Commission. Where the insurer declines to review, or does not complete the review within 28 days, the same 28 day window generally applies from that point. If you want to challenge a Commission medical assessment or merit review through a panel, that is also generally 28 days. And separately, if your injuries support a common law claim for damages, court proceedings generally must be commenced within three years of the accident.
There is limited flexibility in some of these timeframes, but relying on it is a poor strategy. The safest approach is simple. Diarise the 28 days the moment a decision letter arrives.
Building a dispute that actually succeeds
Because these decisions are made on the evidence, most successful disputes come down to what you put in front of the reviewer rather than how strongly you disagree.
Start by reading the decision letter closely and identifying precisely what has been decided and on what basis. Insurers must give reasons, and the reasons tell you what you need to answer. From there, work out what evidence would meet that reasoning. If the insurer says you have capacity for work, you need medical evidence that addresses your capacity, not simply your diagnosis. If it says your injury is a threshold injury, you need evidence that speaks to the statutory definition, such as a specialist opinion identifying a nerve injury or a diagnosed psychiatric illness. If it disputes your earnings, you need payslips, tax records and employment evidence.
Consider a realistic example. A woman’s weekly payments are reduced after the insurer’s own doctor concludes she has capacity for lighter work, even though her treating GP disagrees. Rather than simply objecting, she obtains a specialist report and a functional capacity assessment that address what she can actually do in a workplace, and lodges them with her internal review application. That is the kind of targeted evidence that gives a review a genuine chance of success. This example is illustrative only, and every dispute depends on its own facts.
Keep copies of everything, put your request in writing, and make sure your Certificate of Fitness is current and lists all of your injuries, including psychological symptoms and any earlier condition the accident has worsened.
How Stephen Young Lawyers can help
You can run a dispute yourself, and some people do. But a CTP dispute is a fight about evidence and about which pathway your issue belongs in, and the insurer has its own lawyers and doctors working to support its position. An experienced personal injury lawyer makes sure the decision is properly analysed, that the right evidence is obtained to answer it, that the application is lodged in the correct stream and within time, and that the argument is put as strongly as it can be.
We also look beyond the immediate decision. A threshold injury finding or an impairment assessment does not just affect your benefits today, it can determine whether you can pursue a common law damages claim later, so these disputes need to be run with an eye on the whole claim.
If you want to read more about specific decisions, we have separate guides on what to do when your CTP insurer stops your weekly payments and on disputing a threshold injury decision. If you are at an earlier stage, our guide on how to make a CTP claim in NSW walks through the process from the beginning.
Because motor accident injuries often overlap with other entitlements, we can also advise whether you have a related claim. If your accident happened while you were working, you may also have a workers compensation claim alongside your motor vehicle accident claim, and if your injuries have permanently affected your ability to work, a Total and Permanent Disability claim through your superannuation may be available. 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 the decision and tell you where you stand.
An insurer’s decision is an opinion formed on the evidence in front of it. Change the evidence, and you can change the decision.
Speak with an experienced motor accident lawyer today
If a CTP insurer has made a decision you believe is wrong, anywhere in New South Wales, do not accept it as final and do not let the 28 day deadline pass while you decide what to do.
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 the decision and your options for challenging it.