The kinds of "no" the insurer can throw at you
The decisions that most often get disputed:
- Liability denied. The insurer says the crash wasn't their insured's fault, or that you're wholly at fault. Affects whether you get damages at the end.
- Late submission challenged. The insurer says you submitted outside 28 days without a "full and satisfactory explanation" — and won't backdate your benefits.
- Threshold classification. The insurer says your injury is threshold (soft tissue / minor psychological), closing off the damages track even though the medical evidence points elsewhere.
- Treatment not reasonable and necessary. The insurer refuses to fund ongoing physio, surgery, or specialist appointments.
- Income-payment cut-off. The insurer says you're fit to return to work, and stops the weekly payments — sometimes before your treating doctor agrees.
- Quantum dispute. The insurer offers a settlement amount you think is too low.
All of these are reviewable. Some have shorter dispute windows than others, so timing matters.
Step 1 — internal review
Required first step for most CTP disputes. You submit a written internal review request, the insurer assigns a different claims officer to look at the decision, and they have a fixed window to respond. Most insurers respond inside 14 days; the legislative window is 14 days for some decisions and longer for others.
Internal review is free. About a third of internal reviews land a different outcome, especially where you submit fresh medical reports or point out a factual error in the original decision.
What to include:
- The original decision letter (date, decision-maker, claim number).
- What you think they got wrong, in plain terms.
- Any fresh evidence — new medical report, witness statement, GP letter, dashcam footage.
Step 2 — Personal Injury Commission
If internal review confirms the original decision (or the insurer doesn't respond in time), the dispute escalates to the Personal Injury Commission. The Commission is an independent decision-making body — not part of the insurer, not part of SIRA. Its decisions are binding.
Two main tracks:
Medical dispute track
For disputes about your injury — threshold classification, whole-person impairment percentage, what treatment is reasonable and necessary. Decided by a medical assessor (a qualified specialist) on the file, sometimes with a physical examination. Usually decided on paper.
Merit review / claims dispute track
For disputes about liability, payment amounts, late-submission acceptance, and other claims-handling decisions. Decided by a Commission member, often on paper but sometimes with a directions hearing or full hearing.
Whichever track applies, the Commission decision is binding on the insurer. They can appeal in narrow circumstances; in most matters, the decision is final.
Step 3 — review of Commission decisions
Most Commission decisions can be reviewed once by a Presidential member of the Commission, on procedural-fairness or error-of-law grounds. Genuine court appeals are rare in CTP matters — the scheme is built to resolve disputes within the Commission framework.
Common timeframes
- Internal review — submit within 28 days of the decision (some categories). Insurer typically responds inside 14–28 days.
- PIC dispute application — usually within 28 days of the internal review outcome, or sooner where the timeframe is shorter.
- PIC decision — medical disputes are often decided within 3–6 months; claims disputes can take 6–12 months depending on complexity.
These are guides, not guarantees. Specific time limits depend on the type of decision being disputed.
What we do for you
We run the dispute. Internal review request, medical evidence gathering, PIC application, written submissions, and representation through any hearing. Legal costs on disputes are regulated and capped under MAIA 2017 — in most successful matters the insurer pays them. We don't take a cut of your damages.
If you've got a refusal letter sitting on your kitchen table, don't leave it. The dispute window is running. One call: (02) 7238 7379, or take the short check at /check.
Related reading
See also: CTP claim denied — the full play, all CTP time limits, and do I need a lawyer for CTP.