Being involved in a car accident can negatively change your life and reduce your ability to earn. That’s why there are insurance schemes like Compulsory Third Party (CTP) to help you get properly compensated and help you cope with post-accident life.
However being an accident victim doesn’t always guarantee a successful CTP compensation claim. There are several guidelines that you need to comply with to increase your chances of receiving proper CTP compensation. Failure to comply with them may affect your compensation claim.
In this guide, we’re going to explore the common reasons why CTP claims get denied. We’ll also uncover the steps you can take following a denied claim, and tips to ensure you bulletproof your claim.
Reasons why CTP Claims may be rejected
Your CTP compensation claim may be rejected due to the following reasons:
- Late claim lodgement
- Claim did not involve a motor vehicle accident
- Claim involved an uninsured, unregistered, or unidentified vehicle
- Claim related to a serious driving offence
- Insufficient information was provided to the insurer
Late claim lodgement (more than 90 days after the accident)
Late claim lodgement is one of the leading causes of claim denial. Some accident victims, mostly those who lodge the claim themselves, aren’t aware of or simply don’t adhere to the claim timelines.
In NSW, you’re required to complete the compensation claim for medical expenses and lump sum payment within 28 days of the accident.
Claim did not involve a motor vehicle accident
The CTP scheme covers people injured in a motor vehicle accident including drivers, passengers, motorcyclists, pillions, cyclists, and pedestrians. Your claim may be denied if it didn’t involve a motor vehicle.
In fact, if you’re found to have intentionally been dishonest when you weren’t in a motor vehicle accident, you might be liable for CTP fraud.
Claim involved an uninsured, unregistered, or unidentified vehicle
All vehicles in NSW are required to be properly registered and insured. If you’re involved in a motor vehicle accident and you didn’t have proper registration and insurance coverage, your CTP compensation claim may get denied.
Suppose the accident was a hit-and-run or the driver that caused the accident wasn’t properly registered and insured. In that case, it might be difficult to claim compensation under CTP since the car is unidentified or doesn’t have a policy.
However, you can make an application and get properly compensated under the Nominal Defendant scheme.
Claim related to a serious driving offence
If the at-fault driver is charged with a serious driving offence leading to the accident, they’re excluded from making a compensation claim under the CTP scheme.
Insufficient information was provided to the insurer
For the CTP insurer to make a decision, they need sufficient information including medical reports, evidence of the accident, other vehicle details, police report number, proof of income, and receipts you want to be reimbursed.
Reasons why CTP Common Law damages claims may be rejected
If you sustained severe injuries from the accident, there are chances that you might be eligible for compensation through common law damages. Common law damages is a lump sum payment that is granted to the claimant as compensation for past and future income loss and pain and suffering.
But just like ordinary CTP claims, your common law damages claim isn’t guaranteed. It might get rejected due to the following reasons:
- You were at fault for the accident
- Your injuries were below threshold
- You’re claiming for non-economic damages but you have a WPI of less than 10%
You were at fault of the accident
Lump sum compensation is more likely to be paid out to accident victims who weren’t at fault for the accident. If you’re found to have been wholly at fault, then you’re not eligible for CTP compensation. If you were partially at fault, you might still be eligible but your maximum payout might be reduced due to “contributory negligence”.
Your injuries were below threshold
According to the State Insurance Regulatory Authority, your injuries need to be determined to be above threshold. Above threshold injuries are those that are more than minor, need more medical attention, and take longer to heal. In other words, your injuries need to be serious.
Below threshold injuries are soft tissue injuries, such as muscle injury, whiplash, ligament injury, and sore neck or back. On the other hand, above threshold injuries include broken limbs, spinal injuries, and head or brain injuries. Psychiatric illness as a result of the accident is also categorized under above threshold.
If your injuries were below threshold, your CTP common law damages claim might get rejected.
However, some injuries that were previously assessed to be under threshold might develop and become more serious over time. In such a case, it might be worthwhile to get a reassessment.
You’re claiming for non-economic damages but have a WPI of less than 10%
Pain and suffering compensation under common law damages is granted to victims found to have a whole person impairment (WPI) of more than 10%. If the medical assessor finds your WPI to be less than 10%, you will not be eligible for lump sum compensation.
Disputing a CTP Claim denial
If the insurer has denied your CTP claim, it doesn’t mean that that’s the end of the road. The insurer will have to provide their reasonings for denial via a letter. It’s not uncommon for the letter to be high-level and vague. At this point, your lawyer can review this letter and work towards finding a solution.
There are two ways to go about this:
Insurer Internal Review
An internal review is when the insurer takes another look at a decision they’ve previously made about your claim. This would require the insurer to have another person who wasn’t directly involved in the original decision to review your claim.
You need to request an IIR within 28 days of receiving the insurer’s decision. This timeline is important to note since the insurer may reject late IIR applications.
If the insurer accepts your IIR application, they initiate the review process and provide an outcome within 14 to 21 days. If they need more information to make a decision, this period may be extended to 28 days.
If the decision that has resulted from the IIR is still not favourable, then you can escalate that to the Personal Injury Commission.
Personal Injury Commission
The Personal Injury Commission (PIC) is an independent statutory tribunal that helps resolve disputes between people injured in motor vehicle accidents and insurers in NSW. The PIC exercises its functions in two divisions- the Motor Accidents Division and Workers Compensation Division.
If you escalate the issue to the PIC, the commission can help you and the insurer understand the issues between you and find a mutual resolution to the dispute.
If this isn’t possible, they can also get an independent and expert CTP claim assessor to look at your case and make a binding decision.
You can dispute a denied claim by first going through an Insurer Internal Review and then going through to the Personal Injury Commission if it’s still unresolved. It is important to ensure you have proper legal representation to ensure your interests are protected.
Preventative measures: How to ensure a strong CTP Claim
While it’s hard to predict the outcome of your CTP compensation claim, there are steps you can take to strengthen your case and increase your chances of a positive outcome. These steps include:
Ensure all your injuries are recorded
Ensure a doctor assesses the extent of your injuries and gives your proper treatment. Follow through with the treatment, appointments, and rehabilitation.
The most crucial aspect to remember is to keep records of your injuries. Having clear records from your doctor and certificate of capacity will highly increase the likelihood of a successful CTP Claim.
The insurer will use these records to grant or deny your compensation claim depending on whether your injuries met the eligibility requirements.
Also, keep records of all the medical expenses as they will come in handy when getting compensation for past and ongoing medical, treatment, and care expenses compensation.
Make sure you are aware of timelines
Failure to observe CTP compensation claim time limits is one of the leading causes of claim rejection. Ensure you have a solid understanding of the time limits to adhere to when filing your claim.
The final date to lodge your CTP claim is 90 days after the accident. Once you receive the insurer’s decision but would like to dispute it, you have 28 days to request an insurer internal review.
Keep in mind that a CTP claim is separate from the application for lump sum payment under common law damages. You’ll need to make a separate application for common law damages.
Ensuring you are insured and registered for CTP
Your vehicle becomes unregistered when you don’t renew the registration upon expiry or when the registration is canceled or suspended.
In NSW, all vehicles, except caravans and trailers, are required to have a CTP cover. A vehicle is uninsured when it doesn’t have a CTP insurance cover, also known as a Green Slip. If your car is not registered then your CTP insurance is not valid, which will affect your eligibility for a CTP claim.
By ensuring your car is properly registered and insured, you ensure that you are eligible to make a CTP claim.
Working with expert CTP claim lawyers
Going through the legal aspects of filing a CTP claim by yourself while focusing on medical treatment and getting your life back together can be an uphill task. Keep in mind that many insurance companies will thoroughly scrutinize your application looking for loopholes to minimize the settlement.
Don’t forget that the insurance company will also hire a team of lawyers, medical professionals, and insurance experts. Alliance Compensation & Litigation Lawyers will uphold your rights, ensure your interests are protected, and negotiate with the insurance companies on your behalf.
Had your CTP claim denied?
Reach out to our expert CTP Claim Lawyers who can help investigate your claim and ensure no stones are left unturned. With our No win no fee policy, there is absolutely no risk in engaging with us to assist. Call us now at (02) 8764 1776 & email us at refer@acll.com.au, or book in a free consultation.
