If you disagree with an insurer's decision you will usually need to request an internal review by them before you can bring the dispute to us to resolve.
What is it?
An internal review is when an insurer reviews a decision they have previously made about your claim.
The internal review will be conducted by a person with the required skills, experience, knowledge and training, who did not have a role in the original decision. It can result in the decision being changed, or remaining the same.
The reviewer will consider the information used in the initial decision, as well as any further information you provide in support of your internal review application.
It is important to know you need to make your application for the insurer internal review within 28 days of receiving the insurer decision. The insurer is required to complete a review if your application is received within 14 to 21 days of the original decision, but it can choose not to do so for applications received after that time.
Who can apply for an insurer internal review?
You can apply for an internal review if you are not satisfied with a decision made by an insurer.
General complaints about the insurer, not related to a decision about your claim, will need to be handled as part of the insurer's standard complaints process.
How to apply
Contact the insurer. They may ask you to complete a form and/or provide information supporting your request for review. You can submit any information you think is relevant to the decision being considered, however you should make sure you include:
- why you want an internal review of the decision
- what outcome you are seeking from the review
- what part of the decision you think should be reconsidered (for example, the amount of weekly benefits you receive, and why)
- any additional documents or material you believe will be relevant to the review.
What happens next
4. Refer to us if you wish: If you are unhappy with the outcome of the insurer's internal review then you may be able to have the decision reviewed by us. Please see our disputes section to see which matters can be examined by our Disputes Resolution Service team.
Where can I get help?
- Visit the SIRA website www.sira.nsw.gov.au
- Contact the insurer's claims manager
- Call CTP Assist - an information service provided by the State Insurance Regulatory Authority — on 1300 656 919.