CTP Claims – Motor Vehicle Accident Compensation Payouts in NSW.
If you’ve been injured in a motor vehicle accident in NSW, the compensation payments you receive through a CTP claim can be a massive help while you get treatment for your injuries or take time off work to recover. And if your injuries are serious, a lump sum motor vehicle accident compensation payout could be a real lifeline.
But how do you know if you’re getting all the payments and lump sums you’re entitled to? And what if you disagree with the insurer’s decision on your CTP claim? The compensation payout you receive will depend very much on how your injuries are classified. If your injuries aren’t assessed or classified correctly, or details that may seem minor are overlooked, you could miss out on significant payments you’re entitled to.
In this article, we explain simply and clearly what your rights are when it comes to motor vehicle compensation payouts in NSW, and how to make sure you receive everything you’re entitled to, including any lump sums.
If you’ve already submitted a CTP claim but you’re unhappy with the insurer’s decision and you feel like you might be missing out on benefits or lump sums you’re entitled to, you might prefer to skip to the section on disputing a CTP insurer’s decision.
What you need to know about CTP compensation payouts in NSW.
We’ve handled thousands of successful CTP injury claims for our clients. Based on our experience, here are the top five situations that could put you at risk of missing out on entitlements:
1. Your medical assessment didn’t take into account all of your injuries.
When your doctor assesses your injuries, they might focus only on the obvious injuries caused by your accident. But to get your full entitlements your assessment needs to include every detail, no matter how small it seems. For example, severe side effects from taking pain medication could be the difference between a ‘threshold’ and ‘above threshold’ assessment, adding tens of thousands to your CTP payout.
2. You’ve had essential treatment or surgery denied by the CTP insurer.
Many clients come to us because they’ve had treatment or surgery denied. But we can dispute insurers’ decisions, and we have a strong track record in getting them overturned.
3. Your injuries have worsened over time.
This is easily overlooked. If your injuries have worsened or led to other complications, your original assessment may no longer be valid, and you might be entitled to additional benefits or a lump sum payout.
4. The insurer has argued that you were partially at fault (contributory negligence).
If you were partially at fault for the accident your compensation entitlements will be reduced. However, we have successfully challenged insurers on this point many times and won additional compensation for our clients.
5. The insurer has argued that your injury wasn’t caused by the accident (pre-existing condition).
This is also a situation we come across quite often, where an existing injury or condition may have been made worse by the accident. Again, we have successfully challenged insurers on this point many times and won compensation for our clients that was initially denied by the insurer.
Read on to learn more about how to make sure you receive all of your entitlements, or you can call 13 15 15 to chat with one of our specialist CTP solicitors and get some free legal advice.
- What can I claim on CTP insurance?
- Lump sum CTP compensation payouts
- How to claim CTP insurance in NSW
What is a CTP claim in NSW?
A CTP (Compulsory Third Party) claim is an insurance claim you make to get compensation for being injured in a motor vehicle accident. The compensation is paid to you by the CTP insurer of the vehicle that was at fault.
It’s compulsory for all vehicles driving on NSW roads to have CTP insurance. If you’re injured in an accident involving a car or any other vehicle you can make a CTP claim for compensation to cover certain losses you’ve incurred. These losses can include past and future lost earnings, medical, treatment and care expenses, and pain and suffering.
The NSW CTP claim process is regulated by SIRA (the State Insurance Regulatory Authority) but claims are assessed and processed by the CTP insurers. The NSW CTP insurers are NRMA Insurance, QBE, GIO, Allianz, AAMI and YOUI.
What can I claim on CTP insurance?
The first step in claiming your full entitlements is to understand all the payments that may be available to you. CTP insurance provides personal injury benefits, and lump sums for more serious injuries.
Personal injury benefits include:
|CTP Compensation Payment Process
|Medical and treatment expenses
|Income support payments
Lump sum CTP compensation payouts in NSW.
In NSW, lump sum CTP compensation payouts (common law damages) are available to people with above-threshold injuries who are not at fault. A lump sum claim is the only way to get income support beyond 24 months after your accident, and these lump sum payments can be substantial.
- CTP compensation payouts for above-threshold physical injuries are for more serious injuries like fractures. They also include nerve injuries, injuries that require surgery, brain injuries, and scarring.
- CTP compensation payouts for above-threshold psychological or psychiatric injuries cover diagnosed psychological or psychiatric illnesses such as depression or post-traumatic stress disorder (PTSD), as well as a range of others.
Threshold (minor) injuries.
If you’ve sustained threshold (minor) injuries you won’t be entitled to make a claim for common law damages (for a lump sum payout), however, you’ll still be entitled to claim statutory benefits (weekly wages and treatment) for up to 52 weeks after your accident.
- Personal injury benefits for threshold physical injuries cover soft-tissue or muscle injuries, like a muscle strain or a sore back. The most common soft tissue injury after a crash is whiplash, which often results in neck pain.
- Personal injury benefits for threshold psychological or psychiatric injuries cover injuries such as acute stress disorder and adjustment disorder.
Many injuries get worse over time, and psychological injuries can take some time to develop. So, if your injuries have been assessed as being threshold (minor) injuries but you believe your condition has worsened or you’ve developed symptoms of psychological injuries, you should find out if you’re eligible to claim a lump sum. For example, you may have suffered a threshold whiplash injury, but the pain medication you’ve been taking has caused you serious and permanent digestive issues, which can be regarded as above threshold.
For more information, read our article on lump sum CTP payments.
CTP compensation payout example – $1M payout for single NSW mum.
Layla suffered a broken and dislocated arm, a fractured disc in her lower back and multiple bruises and abrasions to her limbs and torso after her vehicle was slammed into by a taxi. In the 10 months that followed, Layla underwent two major surgeries and experienced chronic pain, to the point where she struggled with work and simple household chores. Her mental health also declined and she was consumed with feeling inadequate.
Layla was unaware she was entitled to a lump sum payout, and the $1M settlement we won for her has completely changed her life. You can read Layla’s full story here.
What is the average CTP payout in NSW?
According to SIRA (the State Insurance Regulatory Authority), in the 12 months to January 2024, there were 12,398 motor accident injury claims reported in NSW and $1.35 billion was paid out in benefits and lump sums. That’s $108,889 paid out for every new claim reported.*
It’s important to understand that your CTP payout amounts will depend on the extent of your injuries and your losses (such as lost income). To get an indication of your CTP payout amount you can use this compensation calculator.
*Based on SIRA Open Data, February 2024
CTP compensation payout example 2 – motorcycle enthusiast awarded almost $200k after being rear-ended.
In February 2018, Joe was stopped at the lights on his motorcycle when he was rammed into by an SUV. He was jolted forward, knocking him off his bike before it fell onto him. He suffered a shattered wrist, dislocated kneecap, two fractured ribs, a ruptured ligament in his neck, and severe lower back bruising.
Law Partners CTP specialist Tanja took time to really get to know Joe and his family to understand the full impact the accident had on them. With this understanding, she built a compelling case and convinced the assessor in the claim to award almost $200,000 in pain and suffering compensation and medical treatment for life.
You can read Joe’s full story here.
How to claim CTP insurance in NSW.
The main tip from our CTP lawyers is to be thorough with your application and make sure you don’t miss any details. If you do, you may miss out on entitlements you don’t even know about. A good starting point is our article on what you need to know about lump sum claims.
Here’s a general overview of how to claim CTP insurance in NSW:
- Obtain a certificate of capacity/fitness from your General Practitioner
- Lodge an application for personal injury benefits on the CTP insurer of the vehicle mostly at fault for the accident
- You have 28 days after the date of the accident to lodge this application to get back payment for any lost wages
- The final deadline for lodging your CTP claim is three months from the date of the accident
- Note that this application doesn’t cover any lump sum payments you might be entitled to – you need to apply for these separately
For a more detailed explanation of how to claim CTP in NSW, please refer to this guide to lodging your application.
What is the CTP claim time limit?
You should make your CTP claim within 28 days to be eligible for income loss protection from the date of the accident. The final CTP claim lodgement date is three months from the accident, although this can be extended in certain circumstances.
If your CTP injury claim is successful:
- You should receive 95% of your pre-accident earnings for the first 13 weeks
- Your payments will drop to 80-85% of your earnings after week 13
- Income benefits will stop after 52 weeks if you were the driver mostly at fault or your injuries are threshold (minor) injuries. If you were at fault and your accident happened before April 1, 2023, your income benefits will be limited to six months.
- In some circumstances, treatment is available after 52 weeks if you have threshold injuries, but not if you were at fault for the accident
- Income support stops at 24 months – to receive support beyond that, you’ll need to submit a separate application for a lump sum (an Application for Damages under Common Law)
How long does the CTP claim process take in NSW?
Once you submit your CTP insurance claim it will be reviewed by the insurer, who must send you a letter within four weeks to tell you if they’re accepting or denying the claim. Then the insurer will start making payments to you within 14 days if they accept the claim.
The CTP insurer will then send you a second liability decision within three months of your claim being lodged. This liability decision indicates whether your injuries have been classified as above or below threshold injuries, and who is at fault for the accident.
However, it’s important to understand that CTP insurer’s decisions can be challenged. The first step is generally to request an “Insurer Internal Review”, then if you’re still not satisfied with the outcome you can escalate your dispute to the Personal Injury Commission.
For more information, read our article on checking and disputing a CTP claim.
Why are my CTP claim benefits being cut off?
If your benefits are being cut off by the CTP insurer, there could be a few reasons why:
- The insurer has determined that you’re no longer entitled to receive benefits as you’re capable of returning to work or your injuries have resolved
- Your injuries were assessed as being threshold (minor) injuries, and you’ve reached the 12-month limit for personal injury benefits
- Your injuries were assessed as above threshold, and you’ve reached the maximum weekly payment period
If your benefits have been cut off and you believe the decision is unfair or you haven’t fully recovered, there’s a dispute process available to you. You can call
Can I dispute a CTP insurer’s decision?
Yes, you can. When you lodge a CTP claim, the CTP insurer determines whether your injuries are above or below threshold, who was at fault in the accident and what payments you’re entitled to. But their decisions can be challenged, so it’s important that you check your payments and dispute them if you believe they’re wrong.
There are two steps you can take to dispute an insurer’s decision:
|Step 1: Request an Insurer Internal Review (IIR).
|If you request an IIR, it means you disagree with the insurer’s decision to reduce or cut off your benefits and you’re asking them to review your case file again.
The letter you receive from the insurer will outline their reasons for cutting you off. You need to address each one of these reasons in your request for an IIR.
|Step 2: Escalate the dispute to the Personal Injury Commission (PIC).
|In most circumstances, you need to request an IIR before you can take your matter to the PIC. The PIC will assist in one of two ways:
-Facilitate the understanding of issues between the insurer and injured persons to mutually resolve these disputes
-Arrange an independent and binding decision by an expert assessor
CTP claim FAQs:
Even if you’re the at-fault driver or the driver mostly at fault, you can make a CTP claim in NSW. However, your personal injury benefits will be restricted to lost income, treatment and care expenses for a maximum of 52 weeks after the accident, or 26 weeks if your accident happened before April 1 2023.
If you were at fault and the other driver was injured, then the other driver may claim personal injury benefits under your vehicle’s CTP insurance policy. You should provide the other driver with your CTP insurer details.
|1. Threshold injury
|2. Above-threshold injury
|3. Above-threshold injury over 10% permanent impairment
*Note: if you were at fault and your accident happened prior to April 1, 2023, your income support, medical, and home care expenses will be limited to six months.
When you make a successful CTP insurance claim, payments will be made to you by the CTP insurer of the car that was mostly at fault in the accident. For example, if you were stationary at traffic lights and you were hit from behind by another vehicle, then the CTP insurer for that vehicle will make your CTP compensation payments. In some accidents there might be more than one vehicle at fault – in that case, it’s the insurer of the vehicle that’s mostly at fault that will pay.
If you’re the driver mostly at fault in an accident, then anyone who was injured in the accident may be able to make a claim under your vehicle’s CTP policy. So it will be your insurer that pays the CTP insurance claim.
The NSW CTP insurers are NRMA Insurance, QBE, GIO, Allianz, AAMI and YOUI.
How can I get free legal help with my CTP claim or dispute?
For CTP claims in NSW, lawyers’ fees are regulated. Lawyers can’t charge to help you lodge your application for personal injury benefits. But if you’re disputing a CTP insurer’s decision, then for most disputes you can engage a lawyer at no cost to you.
There are two types of disputes – paid disputes and unpaid disputes.
- A paid dispute is a dispute that a car accident lawyer can charge for, and the fees are fixed
- Your lawyer will generally earn $1,919* for the dispute. There are legislative restrictions and maximum limits that apply to each claim.
- You won’t have to pay anything to have a lawyer assist you with a paid dispute – these fees are paid by the insurer
- If a lawyer helps you with an unpaid dispute, they must do it free of charge
*As of November 2023
Law Partners is Australia’s largest specialist personal injury firm, and we have a team of specialist motor vehicle accident lawyers. You can call us on 13 15 15 for free legal advice on your CTP claim.
An accredited specialist in personal injury law, backed by over 10 years’ experience in assisting injured Australians receive everything they’re entitled to with their motor accident claim.
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