A CTP claim means you get compensated for your physical and psychological injuries, but it doesn’t always go in your favour. When it doesn’t, you can dispute a CTP claim and take your case to review authorities.
Before you lodge a dispute application for the CTP claim, you need to have all the documents to support your position. An experienced motor vehicle accident lawyer or personal injury lawyer will help you through the entire dispute process, making sure you don’t miss out on any crucial info that can weaken your case.
What Is the CTP Claim Dispute Process?
The CTP claim dispute process has two steps:
Step 1: Internal Insurer Review (IIR)
Requesting an IIR means challenging the insurer’s decision to reduce or stop your benefits and asking them to reassess your case. The letter from the insurer will explain why your benefits were cut off. In your IIR request, you must address each of these reasons specifically to strengthen your case.
Step 2: Escalate the Dispute to the Personal Injury Commission (PIC)
In most cases, you need to request an IIR before you can escalate your case to the PIC. The professional can assist in two ways:
- Resolution – Helping both the insurer and the injured person understand the issues and work towards a mutual agreement.
- Independent Decision – Assign an expert assessor to make a binding decision on the dispute.
Submitting a CTP Dispute Claim: A Step-by-Step Guide to Increase Your Winning Chances
At Wyatts, our CTP lawyers have helped many clients successfully dispute insurers’ decisions. Here are the steps involved in our claim dispute process:
Step 1: Assess Your Treatment and Care Payments
Here’s a quick breakdown of your entitlements to ensure you’re receiving the benefits you deserve:
- All Injuries (First 12 Months) – You are entitled to reimbursement for treatment and care expenses. If the insurer is not covering these costs, you may need to dispute their decision.
- Threshold (Minor) Injuries (Beyond 12 Months) – The insurer will not continue covering treatment and care.
- Above-Threshold Injuries (Beyond 12 Months) – Treatment and care expenses should still be covered by the insurer.
Step 2: Evaluate Your Income Support Payments
Here’s a breakdown of your entitlements to ensure you’re receiving the correct income support:
- Weeks 1-13 – You are entitled to receive up to 95% of your pre-accident earnings.
- Weeks 14-78 – Your entitlement decreases to 80-85% of your pre-accident earnings.
- After Week 78 – Your entitlement decreases to 80-85% of your pre-accident earning capacity.
The insurer will estimate your earnings based on 12 months’ pay slips or other income records. However, this method may not always reflect your actual pre-accident income, leading to an unfair calculation.
Here are two common issues:
- Unpaid Leave: If you took unpaid leave in the past year, your income average may be lower than it should be.
- Job Change or Promotion: If you recently switched jobs or received a raise, your average income may not reflect your new, higher salary.
You can request details from the insurer on how they calculated your income. If their assessment seems incorrect, you have the right to dispute their decision and seek a fair adjustment.
Step 3: Lodge the Dispute
If you’ve reviewed your payments and believe there’s an error—or you’re being denied “reasonable and necessary treatment”—you have the right to dispute the insurer’s decision. Our CTP claim lawyers can manage the entire process on your behalf, but if you’re handling it yourself, here’s what you need to know:
| Steps | Things To Know |
|---|---|
Insurer Internal Review (IIR) | You must request an IIR within 28 days of receiving the insurer’s liability notice. To do that, call the insurer or send a formal IIR request letter. If your dispute involves lost wages, provide supporting evidence showing how the insurer miscalculated your entitlements. Clearly explain why you believe their calculations are incorrect. |
| Personal Injury Commission (PIC) | Strict deadlines apply, so contact us to confirm if you can escalate your case. If your dispute reaches the PIC, an SIRA-approved medical specialist may be required to assess your injuries. You will be referred to an independent doctor for evaluation. |
Our legal team is here to guide you through the process and ensure you receive the benefits you’re entitled to.
Step 4: Consult a CTP Claim Lawyer
Strict time limits apply to IIRs and PIC dispute applications, so it’s crucial to act fast. An experienced personal injury lawyer ensures your dispute is lodged correctly and on time. They can gather the right evidence to strengthen your case.
SIRA generally allows you to have legal representation at PIC at no cost to you. Call us at 1800 773 880 to speak directly with a CTP claim lawyer and explore your options. This service is completely free!
What Are the Most Common CTP Claim Disputes?
If your claim has been denied or reduced, you’re not alone. Here are the three most common CTP claim disputes and how to fight back.
1. Threshold vs. Above-Threshold Injury Disputes
If the insurer has classified your injury as a threshold (minor) injury, but you believe it should be above threshold, you may lose critical income support and treatment benefits. You may also be denied a lump sum claim for future lost income or non-economic loss.
To lodge a dispute claim:
- Obtain a Certificate of Capacity from your GP.
- Ensure all injuries are documented, including new injuries, psychological injuries, side effects from medication, and worsening pre-existing conditions.
Important: You only need one above-threshold injury to challenge the insurer’s classification successfully.
2. Treatment Expenses Denied
If the insurer denies your treatment expenses, they may claim the treatment is not “reasonable and necessary.” Since this definition is subjective, even medical professionals may disagree with the insurer’s assessment.
To lodge a dispute claim:
- Gather medical reports and evidence supporting the necessity of your treatment.
- Understand that insurers have medical and legal teams reviewing these claims, so having a CTP lawyer on your side significantly improves your chances of getting a better deal.
3. Travel Expenses to Treatment Denied
If the insurer refuses to cover travel expenses for medical appointments, they may argue you can use public transport or drive yourself. However, you can dispute their decision if your injuries make travel difficult.
To lodge a dispute claim:
- Provide medical evidence explaining why you cannot travel independently.
- Get a doctor’s report stating why public transport or driving is not a viable option for you.
- SIRA allows legal representation for these disputes at no cost to you—the insurer covers the lawyer’s fees.
When To Contact a CTP Claim Lawyer?
Insurance companies have teams of medical and legal experts who handle hundreds of claims and are skilled at defending their decisions. But that doesn’t mean they’re always right—and it doesn’t mean you should accept their decision without a fight.
Don’t let the insurer undermine your claim—you have rights, and time limits apply. With one of our CTP lawyers on your side, you’ll have the best possible chance of success. We know the laws, the loopholes, and the tactics insurers use—and we’re here to fight for you.
Call 1800 773 880 today to speak with a CTP lawyer for free.
