Frequently Asked Questions for injured persons /
How is my application managed by the Dispute Resolution Service(DRS) and who is my Dispute Resolution Officer (DRO)?
Your application will be allocated to a Dispute Resolution Officer (DRO). The allocated DRO is your primary contact person responsible for the management of your application.
The DRO notifies all parties how the application is to be managed, contacting you within three working days of receiving your application. If you are not sure who your DRO is, you can contact Concierge on 1800 34 77 88.
Will I receive acknowledgement of my DRS application
A notification with instructions is sent to all parties to acknowledge that a DRS application was lodged. The notification also requests the insurer provide a reply.
Your DRO contacts all parties in dispute and can request additional information. You are given your DRO’s contact details and a DRS case number. The DRO’srole is to assist the parties in clarifying and resolving the dispute directly.
Whena resolution cannot be reached between the parties, an independent DRS Decision Maker is allocated to consider your dispute and provide a determination.
I want to find out about the progress of my DRS application
To find out about the progress of your DRS application, contact your DRO. If you are not sure who your DRO is, contact the Concierge on 1800 34 77 88.
Do I need legal representation?
If you feel you need a lawyer to represent you, make sure they have expertise handling motor accident claims. The Law Society of NSW can provide you with a list of personal injury accredited specialists in your area through their Community Referral Service and they can be contacted on 02 9926 0300 or 1800 422 713 if you live outside of Sydney.
If you wish to speak to someone about legal representation, please refer to CTP Assist on 1300 656 919.
What do I do if I have new information about my claim?
When there is new information about your claim you can inform your insurer. If you have a dispute application with your insurer and know your assigned DRO, contact the DRO to discuss.
Can a representative lodge a DRS application on my behalf?
A personal representative can lodge a DRS application on your behalf. The representative is required to register their own account with Service NSW before lodging the application in the online SIRA Dispute Resolution Services portal.
Any communication or documents required to be sent to you, will be sent to your personal representative. We may contact you directly to make arrangements for medical examinations, teleconferences, or assessment conferences where your attendance may be required to assist in the quick resolution of your dispute.
Who can I contact if I have special requirements?
If you have special requirements you can request the following from your DRO:
- An interpreter – if English is not your first language we can arrange access to an interpreter service.
- Disabled access requirements – if you have disabled access requirements advise your DRO who will consider your requirements.
- Visual disability requirements – if you have visual disability requirements advise your DRO who will consider your requirements.
- Special location requirements – we endeavour your location requirements are considered when determining an appropriate DRS decision maker and location.
- Support person – you can be accompanied to a medical examination by a support person or carer however your support person cannot respond to questions or speak on your behalf unless invited to do so.
I have a dispute for a motor accident before 1 December 2017. What changes for me? Do I need to reapply?
If you have a current dispute you do not need to reapply. Your dispute will continue to be managed in the previous scheme.
I need my application dealt with as quickly as possible
You may request that an application to DRS be expedited by contacting the DRO and providing your reasons why your application should be expedited. The DRO will consider all relevant factors and circumstances surrounding your application.The DRO will take all reasonable steps to ensure your application is dealt with as quickly as possible.
The SIRA Dispute Resolution Service portal isn’t working
If you are trying to lodge a DRS application and the Dispute Resolution Services portal is not working contact the Concierge on 1800 34 77 88 and they will advise our IT support team.
What are the different dispute types and timeframes?
What is a Merit Review?
It is a review of whether an insurer’s decision is legally and factually correct. The merit reviewer ‘stands in the shoes’ of the insurer and makes a decision afresh based on the material then before the reviewer. The reviewer must make the most correct and preferable decision. ‘Correct’ means that the decision must be legally correct. ‘Preferable’ means that if discretion is available it is exercised in the way that would best promote the objects of the statutory scheme.
What are the timeframes for my Merit Review?
You must lodge a merit review application within 28 days of receiving the insurer’s internal review decision. The insurer will lodge a reply with DRS within 7-14 days and you will receive a copy of this reply. The DRS merit reviewer conducts the merit review, makes decisions and issues a certificate to you and the insurer within 28 days of the application.
What is the process of a Medical Assessment?
After we receive your medical assessment application, it is reviewed and in most cases allocates a Medical Assessor. A Medical Assessor is atreating health practitioner (or other suitably qualified person) with expertise in resolving medical disputes relating to motor accident claims.
After reviewing the application form, reply form, and any relevant documentation, the DRO will arrange an appointment with the medical assessor so they can carry out a medical assessment examination.
Depending on your injuries, you may need to attend more than one medical assessment examination with different medical assessors.
The DRO will send you a letter with all the medical assessment examination details (e.g. medical assessor’s name, location, date and time).
It’s important you attend all medical assessment appointments we arrange for you so your medical dispute can be resolved quickly.
What are the timeframes for my Medical Assessment?
You can lodge a medical assessment application within 28 days of receiving the insurer’s decision. The insurer will lodge a reply with the DRS within 14 days and you will receive a copy of this reply. The DRO prepares for the medical assessment, contacting the parties and arranging the medical assessment. The DRS Medical Assessor conducts the medical assessment, makes decisions and issues a certificate to all parties within 14 days of the application.
What is the process of a Claims Assessment?
After we receive your application or reply form the DRO review it and in most cases allocate it to a Claims Assessor.
A Claims Assessor is an independent lawyer with expertise in assessing compensation and resolving motor accident claims.
After reviewing the application form, reply form, and any relevant documentation, the DRO will arrange for a Claims Assessor to look at all of the information provided by the parties and make an impartial decision.
After reviewing all of the information, the DRO may ask you and the other party to take part in an assessment conference.
What are the timeframes for my Claims Assessment?
After you and your insurer have agreed on a proposed damages settlement, the insurer lodges a damages settlement approval application on behalf of both parties with the DRS within 7 days of the parties agreeing to settle, attaching all relevant documents. The DRO prepares for the damages settlement approval contacting the partiesand arranging the approval. The DRS Claims Assessor considers the proposed approval, makes decisions and writes brief reasons. The DRS Claims Assessor issues a certificate to all parties within 7 days of the application.
What is a Miscellaneous Claims Assessment?
Miscellaneous Claims Assessment includes:Recovery from at fault vehicle insurer or was the accident the fault of another or injured person is mostly at fault or serious driving offence exclusion.
What are the timeframes for my Miscellaneous Claims Assessment?
After you have received your insurer’s internal review decision and reasons, you can lodge a miscellaneous claims assessment application with DRS within 28 days of receiving the insurer’s decision. The insurer will lodge a reply with DRS within 7-21 days with all relevant documents and sending a copy to you. The DRO prepares for the miscellaneous claims assessment contacting the parties, narrowing or resolving the issues and arranging the assessment. The DRS Claims Assessor conducts the miscellaneous claims assessment, makes decisions and writes brief reasons. You and the insurer receive the DRS Claims Assessor’s decision and brief reasons within 7 days of the assessment.
What is the difference between a merit review and a miscellaneous claims assessment?
Merit reviews and miscellaneous claims assessments deal with different types of matters. The different types of matters are listed in Schedule 2 of the Act.
Only a claimant may apply to the DRS for a merit review. However, any party may refer a miscellaneous claim assessment matter to the DRS for assessment.
A merit reviewer decides what the correct and preferable decision is having regard to the material then before the reviewer. A claims assessor assesses a dispute on such information as is conveniently available to the claims assessor, even if one or more of the parties to the assessment does not co-operate or ceases to co-operate.
Under the Act, a merit review decision may be subject to further review by a panel of merit reviewers. However, for any other than an obvious error, only judicial review is available to challenge a miscellaneous claims assessment.
What happens if I don’t agree with the decision maker’s decision?
If you do not agree with the decision maker’s decision a request can be made for a review of the decision within 28 days. Each dispute can request one review.
When requesting a decision review, clear reasons why the decision is wrong and evidence or supporting documentation is required.
Who can I call if I need help?
If you need help with your dispute application, contact the Concierge on 1800 34 77 88.
StateInsuranceRegulatoryAuthority / 129 November 2017 Version 1.0