If you had an accident on or after 1 December 2017 your personal injury claim is covered by the Motor Accident Injuries Act 2017.
What is a dispute
A dispute occurs when there is a disagreement with an insurer’s decision.
If you are not happy with the decision from an insurer, most (but not all) will need an Insurer Internal Review (IIR) – ask the insurer how to apply.
If you continue to have a dispute with the insurer about your claim, you may apply to the Dispute Resolution Service (DRS) to assist you reaching a resolution or independent determination of your dispute.
Services provided by DRS
If you disagree with a decision your insurer has made about your claim, DRS can assist in resolving your dispute in one of two ways:
- Facilitate the understanding of issues in dispute between insurer and injured persons to mutually resolve these disputes.
- Arrange an independent and binding decision by an expert assessor.
DRS assessment services and examples of disputes
While there are many types of issues that may be in dispute, there are four broad categories which DRS uses to categorise and assess your dispute.
Merit Reviews resolve disputes about merit issues such as weekly benefit payments, treatment & care, and other related disputes
Before you read below, watch this short video on a merit review.
A Merit Review can be requested for disputes about the amount of your weekly benefit payments, your treatment and care payments, or other related disputes.
After an insurer has undertaken an Insurer Internal Review, you can lodge a DRS application for issues such as:
- weekly benefit payments (including benefit reductions or suspensions)
- treatment and care provided and whether it is 'reasonable'
- an insurer delaying making you an offer
- funeral expenses
- other related disputes.
You can also lodge a DRS application without an Insurer Internal Review for:
- a request made by an insurer and whether it is 'reasonable'
- issues around whether particulars of your claim have been provided
- legal costs in a statutory benefits claim.
Medical Assessments resolve disputes about medical issues such as permanent impairment, earning capacity, minor injury, and other related disputes
A medical dispute can arise if an insurer has made a decision on a medical matter that you disagree with.
This can include a decision on the degree of impairment to earning capacity, permanent impairment, minor injury, and treatment and care needs.
These decisions can have an impact on how your claim progresses (e.g. whether or not your weekly benefit payments continue), and will be determined by a DRS Medical Assessor. A DRS Medical Assessor is an independent health professional with expertise in assessing and determining medical disputes.
After an insurer has undertaken an Insurer Internal Review, you can lodge a DRS application to resolve:
- specific treatment and care and whether it is 'reasonable and necessary'
- whether treatment after 26 weeks will improve recovery
- the degree of earning capacity impairment
- whether the injury is a 'minor injury'
- the degree of 'permanent impairment'.
If you have already received a medical assessment certificate and would like to seek a review of the decision, you may apply for:
- a further medical assessment
- a panel review of single medical assessment.
You can also seek advice from a lawyer if you wish.
When you are injured in a motor accident you may be able to make a claim for damages if you have more than a minor injury and you were not at fault. To check if you are eligible to claim, go to motor accidents injury claims. Claims for damages must be made within three years of the date of the motor accident.
Where injuries are greater than 10% ‘whole person impairment’ a claim for damages can be made at any time.
Where injuries are not greater than 10% ‘whole person impairment', a claim for damages can be lodged 20 months after the accident.
If your insurer has made you an offer of settlement you disagree with, declined your claim for damages (or refused to make an offer), or if you wish to have a settlement approved, you can lodge a DRS application for:
- damages claims
- exemptions from claims assessment
- lump sum settlement approvals (if you are self-represented).
If you do not have a lawyer, any proposed damages claim settlement will need to be approved by an independent DRS Claims Assessor.
If you have a dispute with an insurer’s decision on a miscellaneous claims assessment matter, you can lodge a DRS application for the dispute to be determined by a DRS Claims Assessor.
After an insurer has undertaken an Insurer Internal Review, you can lodge a DRS application for Miscellaneous Claims Assessment.
Who can lodge a DRS application to resolve a dispute
Time limits may apply to lodging an application once the insurer's decision is made.
- Anyone over 18 years old, or representing an injured person, can apply.
- Insurers can also lodge a DRS application via the Insurer Portal
- You can apply online, in person, over the phone or by email.
- Lodging a dispute application is free.
How to lodge a DRS application online
The fastest way to lodge your application is online using the SIRA Dispute Resolution Services portal. The portal also allows you to follow the progress of your application through to completion.
- Login/Register an account with Service NSW
- Link your Service NSW account with SIRA.
- Complete the DRS application providing as much detail about your dispute as possible, including when the decision of the insurer was made, what parts of the decision you disagree with, and what you would like the decision to be.
- Upload any documents you want to rely on, such as the original decision.
Click here to watch an instructional video on preparing to lodge a dispute application.
How to lodge a DRS application by email, post or in person
- Download the DRS application form (pdf)
- Complete the form and attach your supporting documentation
- By email: firstname.lastname@example.org
- By post: Level 19, 1 Oxford St, Sydney; DX10 SYDNEY
- In person: Level 19, 1 Oxford St, Sydney – 9am to 5pm Monday to Friday.
If you need more space to list extra documents on your form, use this extra document information form. Continue the numbering and attach it to your application.
If you have any enquiries before submitting, you can call us on 1800 34 77 88
What happens next
Once you've completed and lodged your DRS application:
- Notification and Reply: A notification with instructions will be sent to all parties to acknowledge that a DRS application has been received by us. The notification will also give the insurer an opportunity to provide a reply.
- View the status of your application: Log back in to view the current status of your application. Click here to watch a brief instructional video on how to identify the current status of your application in the system.
- Requesting Information: A Dispute Resolution Officer (DRO) will contact the parties in dispute and may request additional information. The DRO will be your contact for the dispute resolution process. You will be given their contact details and a DRS matter number.
- Resolution: The DRO will assist the parties in clarifying and resolving the dispute directly between the parties.
- Determination: If no resolution can be reached between the parties, an independent DRS decision maker will be appointed to provide a decision for the issue in dispute.
- Next Steps: If you do not agree with the DRS decision there may be different options to challenge the decision. These will vary depending on the nature of the decision. For further help call CTP Assist or discuss with your lawyer. The Law Society of NSW can help.