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The most common disputes, and how to deal with them.

Most disputes are based on three very common insurer denials.

The first step in the dispute process is to request an “Insurer Internal Review”, or IIR. You must do this within 28 days of receiving the liability notice letter from the insurer.

If you’re not satisfied with the outcome of the insurer internal review, you can apply to SIRA’s Dispute Resolution Service (DRS) to help resolve the dispute.

If you’ve requested an Insurer Internal Review (IIR), it means you disagree with the insurer’s assessment or decision to reduce or cut off all your benefits, and you’re asking them to review your case file again.

Let’s look at each one of these separately.

Minor / non-minor injury definition.

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 common law claim for a lump sum, to compensate you for future lost earnings or for pain and suffering.

If you’re requesting an IIR on the basis of minor/ non-minor injury definition, you’ll need a certificate of capacity from a GP to support your position. It’s very important to make sure all your injuries are noted in your certificate of capacity – including any new injuries, psychological injuries, side effects from medication or pre-existing conditions that have worsened. Remember, even though most of your injuries may be classified as minor, you only need to have one injury that falls into the non-minor category to successfully argue with the insurer’s position.

Please refer to our articles on how to get a head-to-toe assessment and minor and non minor injuries explained for more information.

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 – your first step should be to seek legal advice on where you stand.

Travel expenses to see treatment provider denied.

Many injured people find themselves in a position where the insurer refuses to may 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. You’ll need to show medical evidence that supports your position – such as a medical report that shows why you can’t drive, or why it’s hard for you to use public transport.

If you plan to lodge a dispute, you’ll have a much better chance of success with legal experts on your side. SIRA does allow you to engage a lawyer for what’s known as a “paid dispute”, and the lawyer’s fees are covered by the insurer. So if you find yourself in a position of having your benefits cut off, or treatment expenses or travel expenses denied, your first step should be to seek legal advice on where you stand.

 

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.

What do I do next?

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Once you’ve filled out the online form, one of the team from CTP Claim Advice will call you to check on the status of your claim, and arrange your free one-on-one claim review with a specialist CTP lawyer.

 

If you need legal representation, we’ll offer you an experienced CTP lawyer who will have the full history of your claim and be able to immediately act on your behalf. For many claims there will be no cost to you whatsoever- we’ll fund your claim, and recover our costs from the insurer.

 

If we find that you’re eligible for a lump sum over $75,000, we’ll offer to fund your claim and work for you on a no win no fee basis, and only get paid after you receive your lump sum. So you’ll never be out of pocket.

 

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