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 under Entitlements.

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:

• Claim within 28 days of the accident to receive weekly income payments from the accident date.
• Weekly income payments are not usually payable from the date of the accident for claims submitted after 28 days.
• Claim 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. Directly notify the insurer of the at-fault vehicle or use SIRA’s CTP Connect 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 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) by lodging these two forms:

• Application for personal injury benefits
• Certificate of fitness for work.

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

• Application for funeral expenses

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

• Within 4 weeks, for weekly income payments in the first 52 weeks after the accident
• Within 3 months, for weekly income payments after 52 weeks.

If you disagree with the insurer’s decision, you can apply for an Internal 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 52 weeks of payments, claimants are allowed to request further treatment for threshold injuries.

Steps to make a claim for damages

A claim for damages can be submitted up to 3 years after a motor accident.

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

• Application for damages form
• Application for personal injury benefits form
• Evidence of income.

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 for 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 the Personal Injury Commission or the lawyer acting on the claimant’s behalf.

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

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.