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Claims – Making a Claim

Making a claim under the NSW CTP green slip scheme

This information is based on the new NSW CTP scheme, which began 1 December 2017. The State Insurance Regulatory Authority (SIRA) continues to provide information about claims already made before that date under the old scheme.

Anyone injured in a motor vehicle accident is covered by the NSW CTP scheme and can submit a claim. This includes drivers and passengers, motorcycle riders and passengers, cyclists and pedestrians.

Two types of claim

After a motor accident, there are two types of claim available:

1. Claim for benefits›

There are three types of payment:

  1. Loss of income and
  2. Medical treatment and care, or
  3. Funeral expenses.

2. Claim for damages›

There are two types of damages claim:

  1. Economic – Loss of past income and future earning capacity
  2. Non-economic – Pain and suffering.

Information on eligibilty to claim for benefits and damages is set out in the entitlements section of this website.

Injured parties must call the Police Assistance Line 131 444 within 28 days of the accident. Police will provide an event number for the insurer’s records.

Steps to make a claim for benefits

There are fixed deadlines to submit a CTP claim for benefits:

  • Within 28 days of the accident, to receive weekly income payments from the accident date
  • Weekly income payments will not be payable from the date of the accident for claims submitted after 28 days
  • Within 3 months of the accident, to receive weekly income payments.

1. As soon as possible, visit a GP for medical treatment and request a certificate of fitness for work. Insurers can approve early treatment (one GP visit and two treatment sessions, such as physiotherapy) whether or not you later put in a full claim.

2. Report the accident to the police and get an event number. If you cannot provide the insurer with an event number, you may be asked for additional information (such as photographs of the accident and hospital discharge summaries).

3. Next, directly notify the insurer of the at-fault vehicle or use SIRA’s Online Claim Notification to begin the claims process. You must attempt to find out the registration plate number of the at-fault vehicle before making a claim.

4. Within 3 months, make a full claim by lodging these two forms with the insurer of the at-fault vehicle (if more than one vehicle was involved) or the insurer of the vehicle (if the accident was caused by only one vehicle):

5. To claim for any funeral expenses, lodge with the insurer of the at-fault vehicle:

6. The insurer must make a decision about your claim:

  • Within 4 weeks, for weekly income payments in the first 26 weeks after the accident
  • Within 3 months, for weekly income payments after 26 weeks.

If you disagree with the insurer’s decision, you can apply to SIRA’s Dispute Resolution Service for a Merit Review.

7. Claimants work with the insurer to create a recovery plan. They have to comply with their recovery plan to continue to receive weekly payments. For example, you may need to organise retraining, return to work support or attend a progress review. You have to inform the insurer about any change of circumstances, for example, by providing an updated certificate of fitness to work.

8. After 26 weeks of payments, claimants are allowed to request further treatment for minor injuries.

Claim for Benefits 
Claim types

Loss of Income

Medical treatment and care

Deadline

Within 28 days of accident call Police Assistance Line 131 444

Claim within 3 months, or within 28 days of accident for early weekly payments from that date

First steps

Get medical treatment and certificate of fitness from your doctor

Notify insurer directly or use SIRA online claim form

You can request early treatment before making a full claim

Next steps

For full claim, give the insurer Application for personal injury benefits and Certificate of fitness from doctor

Decision

Insurer must decide:

  1. Within 4 weeks of accident for income payments during first 26 weeks
  2. Within 3 months for income payments after 26 weeks

If you disagree with decision, apply to DRS for Merit Review

Recovery plan

Comply with recovery plan to continue to receive payments, eg, retraining, return to work support, attend progress review

Tell insurer if any circumstances change, eg, provide updated certificate of fitness

Final stage  After 26 weeks you may request further treatment for minor injuries.

Steps to make a claim for damages

Injured people can submit a claim for damages between 20 months and 3 years after a motor accident. In the case of death or more than 10% whole person permanent impairment, a claim can be submitted at any time.

1. To make a claim for damages, lodge these documents with the insurer:

2. Claimants must attend an interview and undergo a clinical examination. The medical assessor will review all available medical evidence and prepare a certificate of impairment. The insurer uses this information to make a decision on its liability for damages.

3. Within 3 months, claimants receive the insurer’s decision on its liability for damages for economic (financial) or non-economic loss (pain and suffering etc). If you disagree with this decision, you can apply to the insurer for an Internal Review.

4. Claimants work with the insurer to create a recovery plan. They must comply with their recovery plan to continue to receive weekly payments. For example, you may need to organise retraining, return to work support or attend a progress review. You must also inform the insurer about any change of circumstances, eg, by providing an updated certificate of fitness to work.

5. The insurer must make a reasonable settlement offer once the claimant’s condition improves and it has an indication of the final lump sum amount. The final claim for damages is settled only after approval from SIRA’s Dispute Resolution Service (DRS) or the lawyer acting on the claimant’s behalf.

Claimants can seek advice at any time on the next steps in making a claim.

Claim for Damages 
Claim types

Economic loss – Past Income and Future Earning Capacity

Non-economic loss – Pain and Suffering

Deadline

Claim within 20 months and 3 years of accident

Claim anytime for death or more than 10% permanent impairment

First steps Lodge with insurer Application for damages under common law and Application for personal injury benefits
Next steps

Attend medical interview and clinical exam

Medical assessor reviews evidence and prepares certificate of impairment

Decision

Within 3 months, insurer decides on its liability for economic or non-economic loss

If you disagree with decision, request Internal Review

Recovery plan

Comply with recovery plan to continue to receive payments, eg, retraining, return to work support, attend progress review

Tell insurer if any circumstances change, eg, provide updated certificate of fitness

Final stage

Insurer makes reasonable settlement offer when claimant condition improves and claim is quantifiable

Damages claim is settled after approval from DRS or lawyer

Note People with minor injuries cannot claim for damages, and only people with 10% whole person impairment can claim damages for non-economic loss.      
 

Information in these tables is intended as a guide and for general information purposes only. It does not take into account your specific needs, objectives or circumstances, and is not advice. When making decisions about claiming, your insurance or any other matters, you must seek legal advice specific to your situation and you should not rely on these tables. While we use reasonable attempts to ensure the accuracy and completeness of the tables, we make no representation or warranting regarding the tables, to the extent permitted by law.

Claims Guide - more info

Getting advice >

Where to go to get advice when making a greenslip claim under the NSW CTP scheme. read more

Disputing a decision >

How to handle different types of dispute in the process of making a greenslip claim. read more

Overview >

Learn about entitlements, making a claim, getting advice and disputing a decision. read more

Entitlements >

Your entitlement to benefits and damages under the NSW CTP green slip scheme. read more