CTP Claims Guide NSW – Know Your Rights.

Man Suffering From Whiplash After Car Accident

If you’ve been injured in a motor accident in NSW, you can claim CTP compensation payments to cover certain losses. These payments 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, lump sum payments can be a real lifeline.

But when you make a CTP claim, how do you know if you’re getting everything you’re entitled to? And what if you disagree with the CTP insurer’s decision on your claim? The amount of compensation you receive depends very much on how your injuries are classified. If your injuries aren’t assessed or classified correctly, you could miss out on significant payments you’re entitled to.

In this claim guide we explain in simple terms what your rights are when it comes to making a CTP claim, and how to make sure you receive everything you’re entitled to.

What’s a CTP claim?

A CTP claim is an insurance claim you make to get compensation for being injured in a motor vehicle accident.

It’s compulsory for all vehicles driving on NSW roads to have CTP (Compulsory Third Party) 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.

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Your CTP Claim.

What benefits can I claim on CTP Insurance?

CTP insurance provides personal injury benefits for drivers under three categories, described in the following table:

CTP Claim	CTP Compensation Payout Process
Medical and treatment expenses	Your GP will provide the insurer with a treatment referral CTP insurer will generally approve a number of sessions with your GP and other treatment providers CTP insurer will generally write directly to your provider and notify them of the approval CTP insurer will pay the GP or treatment provider directly – these expenses won’t form part of your regular payments Benefits are capped depending on the severity of your injuries You should receive whatever treatment is necessary to make sure you recover from your injuries
Care expenses	Generally treated in the same way as medical and treatment expenses.
Income support payments	Weeks 1-13: 95% of pre-accident earnings Weeks 14 – 26: 80-85% of pre-accident earnings. If the CTP insurer cuts off your benefits it will need to give you four weeks’ written notice. Beyond week 26 you can only receive benefits if you weren’t the driver mostly at fault and your injuries have been assessed as non-minor

What if I’m the at-fault driver?

Even if you’re the at-fault driver, or the driver mostly at fault, you can make a CTP claim in NSW. However, personal injury benefits will be restricted to lost income, treatment and care expenses for a maximum of six months after the accident.

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.

Can I claim a lump sum CTP payout?

If your injuries have been assessed as non-minor and you weren’t the driver at fault, you’re entitled to claim a lump sum. 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. Minor and non-minor injuries are explained in the next section of this article.

Read about how a single NSW mum received a $1M lump sum payout she didn’t know she was entitled to.

CTP compensation payouts NSW

What is the average CTP payout in NSW?

In the 12 months to August 2022 there were 9,408 motor accident injury claims submitted in NSW and $865M was paid out in benefits and lump sums.* That’s $91,943 paid out for every new claim submitted.

It’s important to remember that CTP compensation amounts depend on the extent of your injuries and your losses (such as lost income).

Read about how a family man and motorcycle enthusiast received almost $200,000 in compensation after being rear-ended by an SUV driver who was on his phone.

*Based on SIRA Open Data, September 2022.

CTP compensation – what can I claim?

There are two types of CTP claims in NSW:

Lump sum (common law damages) claims
Personal Injury benefits (weekly payments)

Lump sum claims are available to people with non-minor injuries who are not at fault.

Non-minor physical injuries are more serious injuries like fractures. They also include nerve injuries, injuries that require surgery, brain injuries and scarring.
Non-minor 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.

People entitled to lump sum payments are usually also entitled to personal injury benefits.

People with minor injuries can’t claim lump sum compensation but can still claim personal injury benefits.

Personal injury benefits for minor 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 minor psychological or psychiatric injuries are for psychological or psychiatric injuries such as acute stress disorder and adjustment disorder.

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The CTP Claim Process in NSW

How do I make a CTP claim?

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.

What is the CTP claim time limit?

You must make your CTP claim within 28 days to be eligible for income loss from the date of the accident. The final lodgement date is 3 months from the accident, although this can be extended in certain circumstances.

If your 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 26 weeks if you were the driver mostly at fault or your injuries are minor
In some circumstances treatment is available after 26 weeks if your injuries are minor, 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)

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How long does the CTP claim process take in NSW?

Once you submit your CTP insurance claim it will be reviewed by the insurer, which must send you a letter within four weeks to tell you if it’s accepting or denying the claim. Then the insurer will start making payments to you within 14 days if it accepts 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 minor or non-minor 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 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.

How long will I keep getting CTP benefits?

Category	Entitlements
1. Minor injury	Income support, medical and home care expenses for up to 6 months
2. Non-minor injury	Income support, medical and home care expenses that can extend beyond 24 months if there is a claim for damages A lump sum for past and future lost income
3. Non-minor injury over 10% permanent impairment	An additional lump sum for pain and suffering

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 minor, and you’ve reached the six-month limit for personal injury benefits
Your injuries were assessed as non-minor, 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 13 15 15 to get free advice from a specialist car accident lawyer on how to lodge a dispute.

How can I dispute a CTP insurer’s decision?

When you lodge a CTP claim, the CTP insurer determines whether your injuries are minor, 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:

Steps	Process
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).	You must request an IIR before you can take your matter to PIC. The PIC will assist in one of two ways: -Facilitate the understanding of issues between insurer and injured persons to mutually resolve these disputes -Arrange an independent and binding decision by an expert assessor

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 $1,720 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.

Law Partners is Australia’s largest specialist personal injury firm, with legal teams that specialise in CTP claims in NSW. You can call us on 13 15 15 and get free advice on your claim.