What "denied" actually means
A NSW CTP insurer makes lots of decisions on a claim. They decide whether to accept liability. They decide how to classify the injury — "threshold" (sometimes called "minor") or non-threshold. They decide whether each medical treatment is reasonable and necessary. They decide how much weekly income payment is right.
When people say their CTP claim was "denied", they usually mean one of those decisions went against them — not that the whole claim is gone. Knowing which decision you're actually disputing is the first thing to sort out, because the review path is the same regardless.
Step 1 — Internal review by the insurer
Every formal decision the insurer makes comes with a letter explaining your right to ask for a review. You have 28 days from the date of the letter to request it. A different person inside the same insurer takes a fresh look.
Internal reviews are free. They're usually decided within 28 days. And the success rate is higher than people assume — especially when you go in with fresh medical evidence, a clearer history, or a properly framed argument about why the original decision was wrong.
Step 2 — SIRA
If the internal review goes against you (or the insurer doesn't reply in time), the next step depends on what you're disputing. For medical assessment disputes (was the injury threshold or not? was treatment reasonable?) you go to SIRA's medical assessment service. For miscellaneous claim disputes, you can go straight to the Personal Injury Commission.
SIRA — the State Insurance Regulatory Authority — has free dispute resolution paths and independent medical assessors. Their job is to look at the evidence without favouring either side.
Step 3 — Personal Injury Commission
The PIC is the independent NSW tribunal for motor accident disputes. It's free to apply. A presiding member or medical assessor (depending on the type of dispute) looks at all the evidence and makes a binding decision. Most matters settle before they ever get to a hearing — once the insurer sees the file go to the PIC, the maths often changes for them.
The most common reasons claims get knocked back
- "Your injury is a minor / threshold injury." Threshold classification limits how long benefits flow and rules out damages. Plenty of injuries get wrongly classified as threshold at first pass and get reclassified on review. See threshold vs non-threshold injury explained.
- "Your injury isn't related to the crash." The insurer says the pain or symptoms come from something else — an old injury, a degenerative condition, an unrelated event. Fresh medical reports from your treating doctors usually push back on this.
- "You were wholly at fault." Even if you were, at-fault drivers still get up to 52 weeks of statutory benefits. See can I claim if I was at fault for the detail.
- "Paperwork is missing or late." Often the cleanest fix. Provide the document, the claim runs.
- "Treatment isn't reasonable and necessary." Treatment funding is decided one approval at a time. A denial on one treatment doesn't deny the whole claim. We push for the next approval.
What we do for you after a denial
One phone call sorts the next step. We read the decision letter, work out exactly what you're disputing, get fresh medical evidence where it's needed, and write the review request properly so it has the best chance of changing the outcome. If internal review doesn't go your way, we run the SIRA or PIC step too. No fee for any of this — legal costs on damages are regulated and capped under NSW MAIA 2017 and typically paid by the insurer.
Take the short check at /check, or call (02) 7238 7379 and a real person picks up.