Insurer said no, or cut your benefits? What to do next

What to do this week

• Read the letter closely. Find the decision, the reasons, the reports or evidence it relied on, and the section on how to ask for a review.
• Write down the date you received it. Count 28 days from then and put that date in your calendar. That's generally your deadline to ask for an internal review.
• Ask the insurer to explain anything you don't understand. Call your contact person and quote your claim number.
• Gather what the insurer didn't have: a report from your doctor, test results, payslips, photos or witness details.
• If it's a statutory benefits decision, think about getting advice before you apply. The CTP Legal Advisory Service may be able to help (more below).
• Ask for the internal review, following the instructions in the letter. Keep a copy of what you send and the date you sent it.

Decisions the insurer makes

You can ask for a review of most insurer decisions, including decisions about:

• whether it accepts liability for your claim
• who was at fault, and your share of the fault (contributory negligence)
• whether your injury is a threshold injury
• how much your weekly payments are
• whether it will pay for a treatment or care request
• stopping or reducing your benefits
• whether it accepts your explanation for a late claim.

Step 1: ask for an internal review

You can ask the insurer for an internal review, generally within 28 days of receiving the decision. Someone at the insurer who wasn't involved in the original decision looks at it again.

The insurer usually has 14 days to decide (21 days for some medical and fault-related matters, or longer if you give it new information), but never more than 28 days in total.

Send any new information with your request, or as soon as you have it. Explain briefly what you disagree with and why.

No legal costs are payable for legal help with an insurer internal review.

Step 2: the Personal Injury Commission

If you're still unhappy after the internal review, you can apply to the Personal Injury Commission, an independent tribunal. An application for merit review must generally be made within 28 days of receiving the insurer's internal review decision.

You generally need an internal review before going to the Commission, but not for a dispute about your degree of permanent impairment.

What it decides and how to prepare: the Personal Injury Commission.

Legal advice for statutory benefits questions

The CTP Legal Advisory Service (opens in a new tab) is a panel of experienced motor accident lawyers who give confidential phone advice about statutory benefits for crashes from 1 December 2017. There's no separate number: you check you're eligible through SIRA's CTP Assist line, 1300 656 919.

It can advise before or after an internal review, and before you apply to the Commission. It can't advise on damages claims, claims under the older schemes, your internal review application itself, or a matter already in dispute at the Personal Injury Commission.

If you already have a lawyer, the service suggests staying with them.

Complaints about how you're treated

A complaint is different from a review. It's about how the insurer is treating you, for example not returning calls. Complain to the insurer first. It must acknowledge your complaint within 5 business days and resolve it within 20 business days.

If you're still unhappy, contact the Independent Review Office (IRO) on 13 94 76, or through the online form or email address on iro.nsw.gov.au (opens in a new tab).

If you also disagree with the decision itself, ask for an internal review as well, within the 28 days.

Evidence that can change a decision

Reviews turn on evidence. Things that often help:

• a clear written diagnosis from your treating doctor, naming each injury
• scan or test results, and reports from other practitioners who have treated you
• a treatment plan that explains why the treatment is needed for your accident injuries
• payslips, tax returns or business records that show what you earned
• photos of the scene, dashcam footage or witness details, if fault is in question.

When legal help makes sense

Many reviews are straightforward. Legal help tends to matter when a lot turns on the decision, such as a finding that you were mostly at fault, a threshold injury decision, a dispute going to the Commission, or a possible damages claim.

Legal costs in CTP statutory benefits claims are tightly regulated. You can only recover legal costs where the Motor Accident Injuries Regulation or the Personal Injury Commission allows it, the insurer pays those costs, and for some disputes legal costs cannot be recovered at all. Ask any lawyer for a written costs agreement.

How we can help

We can go through the decision with you, help you get your paperwork together and keep track of your dates. If you'd like legal representation, we can introduce you to an independent CTP lawyer. We don't give legal advice and we don't write your review for you.

We're not a law firm or a medical practice. If your case calls for it, we can introduce you to an independent CTP lawyer or a doctor experienced with CTP claims.

Tell us about the decision: start your claim. Or try the quick check: claim denied or cut back?. Other services are listed on help services.

Check the current rules

Rules change. This page reflects the rules as we understand them in September 2026. General information, not legal advice.