The first step in the dispute process is to request an “Insurer Internal Review” (IIR). If you’re not satisfied with the outcome of the IIR, you can apply to SIRA’s Dispute Resolution Service (DRS) to help resolve the dispute.
If you’ve requested an IIR, it means you disagree with the insurer’s assessment or decision to reduce or cut off your benefits
This dispute arises if your injuries have been assessed as minor, but you believe they should have been assessed as non-minor. This could mean that your benefits have been cut off before you’re fully recovered or able to return to work, leaving you unable to support yourself financially or get the treatment and care that you need.
It would also mean you’re unable to make a claim for a lump sum to compensate you for future lost earnings or pain and suffering.
If treatment expenses are denied by the insurer, it will usually be on the basis that the treatment is not “reasonable and necessary”. This is a subjective definition, open to interpretation, and even medical professionals may disagree on whether your treatment is reasonable and necessary.
What you need to understand is that the insurers employ medical and legal experts in this area, who have dealt with many claims and argued their opinion in many disputes. But don’t let that stop you from disputing the insurer’s decision –
call 1800 888 529 for free legal advice on how to succeed with your dispute.
You may find yourself in a position where the insurer refuses to pay for travel expenses to and from treatment providers. This refusal is usually made on the basis that the insurer believes you’re physically able to travel on your own, on public transport or by driving. However, if your injuries are making it difficult for you to travel, you should dispute their decision.
Be clear on your reasons for your dispute.
Read our article on getting help with your dispute.
Call our advice line if you need further assistance.