Making or replying to an application

We can help if a claim for compensation following a motor vehicle accident has been made but the injured person or the insurer can’t agree on aspects of the claims process or compensation (eg the amount).

Either the injured person or the insurer can make an application to resolve a dispute. Then the other party will reply to that application.

This is general information only; we know everyone’s situation is different and can be complex. That’s why we encourage you to call us on 1300 656 919 and we can talk you through which form best suits your needs.

Making an application

You will need to fill out one of these application forms:

Application for general assessment

Use the application for general assessment form if your dispute is because:

  • the insurer has not accepted liability for the claim, or
  • you do not agree with the amount of compensation they are offering

Once we receive this form we’ll provide an independent claims assessor to decide your claim. In most cases they can resolve the dispute and find a solution without needing to go to court.

Applications for exemption

If you have a compensation dispute, under the law you can only go straight to court in limited circumstances. You must first bring your case to us for assessment (that’s where we use an independent assessor to look at the case and determine a resolution).

However some claims are unsuitable for assessment by us.  In these situations you can request an exemption which allows you to go straight to court to have the matter resolved.

You can apply for an exemption if you’ve been told in writing by an insurer that your claim has been denied because of one or more of these reasons:

  • the insurer denies that the vehicle you have claimed against was at fault
  • the injured person is under 18 or has no legal capacity (eg someone who has a brain injury that prevents them for managing their own affairs)
  • the person against whom the claim is made is not a licensed or other CTP insurer (eg someone hit by an uninsured forklift might make a claim against the driver or owner of the forklift; there is no CTP insurer involved in this case)
  • the insurer alleges the claim is a fraudulent claim in terms of the circumstances of the accident giving rise to the claim (eg a person claiming to have been a passenger in the vehicle is alleged to have been the driver of the vehicle)

If these conditions have been met, you will fill out either:

Application for special assessment

Use the special assessment application form for certain disputes in connection with a claim. The most common disputes are because:

  • your claim was lodged late (the legislation sets time limits on when a claim can be made)
  • the insurer says you didn’t report the accident to police on time (or at all)
  • the insurer says your claim form was incomplete or not filled out correctly
  • the insurer believes you haven’t tried hard enough (or at all) to identify the vehicle that caused the accident

Once we receive this form we’ll provide an independent claims assessor to decide your dispute.

Application for further general assessment

Use the further general assessment form when requested as part of a court proceeding because it’s believed there’s significant new evidence that’s important to your claim.

Once we receive this form we’ll provide an independent claims assessor to decide your claim.

Replying to an application

Once an application is made to us to resolve a dispute, the other party (being you or the insurer) will have the chance to respond to the application and provide any additional information.

They fill out one of these reply forms:

Then send in your application or reply

You are required to send a copy of your completed application or reply form and all supporting information to us as well as the other party.

To send to us:

Claims Assessment and Resolution Service
State Insurance Regulatory Authority
Level 19, 1 Oxford St,
Darlinghurst NSW 2010
Or DX 10 Sydney