Insurer internal reviews

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.

Application time limits

You need to make your application for the insurer internal review within 28 days of receiving the insurer decision because late applications may be declined by the insurer.

If the insurer accepts the internal review application, then the insurer will provide the outcome of the internal review within 14 to 21 days. This may be extended up to a maximum of 28 days if further information needs to be requested.

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.

If you are not sure whether your dispute needs to be go to internal review, contact our CTP Assist team on 1300 656 919 or [email protected].

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

1. Contact you: The insurer acknowledge receipt of your application for an internal review within two working days. They will do this in writing, via post or email, depending on your preference.

They are required to explain in detail their internal review process.

2. Carry out the review: The insurer must complete the internal review and notify you of the outcome within either 14 or 21 days of receiving your application. No one involved in the original decision may conduct the review. The internal reviewer may consider additional information that's been received after the decision was made.

3. A decision will be made: On completion of the review, you will receive written notification from the insurer detailing the outcome. The notification must be in plain language and explain how the reviewer reached their decision.

You can call them or us if you need anything clarified.

4. Refer to the Personal Injury Commission 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 the Personal Injury Commission. Please see our disputes section to see which matters can be examined by the Personal Injury Commission.

Where can I get help?

• Contact the insurer's internal review team
• Call CTP Assist - an information service provided by the State Insurance Regulatory Authority — on 1300 656 919 between 8.30 am-5 pm weekdays, or email [email protected]
• If you would like to make a claims complaint about an insurer, please speak with the Independent Review Office (IRO) – on 13 94 76 between 8:30am-5:30pm weekdays, or email [email protected]
• If you would like to seek legal advice you can contact the Law Society of NSW