If your Compulsory Third Party (CTP) or motor accident claim in New South Wales is disputed, you may find yourself involved in a Merit Review or a Medical Assessment.
Both are part of the Dispute Resolution Service (DRS) run by the State Insurance Regulatory Authority (SIRA) under the Motor Accident Injuries Act 2017 (NSW).
While they sound similar, each process deals with very different types of disputes and being properly prepared can make a significant difference to your outcome.
Understanding the two types of reviews
1. Merit Review
A Merit Review examines whether the insurer has made the correct administrative or discretionary decision under the law. It looks at issues such as:
- Whether weekly income payments were stopped or reduced correctly
- Whether medical treatment or rehabilitation expenses were reasonably denied
- Pre-accident weekly earning (PAWE) calculations
A Merit Reviewer can affirm, set aside, or substitute the insurer’s decision. The review is generally based on written submissions, though you may be asked to provide additional documents such as medical reports, invoices or correspondence.
2. Medical Assessment
A Medical Assessment (sometimes called a medical dispute) involves a SIRA-appointed independent medical assessor reviewing medical evidence to decide a factual medical question.
These disputes often concern:
- The degree of permanent impairment (whether you exceed the 10% threshold)
- Whether your injuries are threshold or non-threshold
- Whether further treatment is reasonable and necessary
- Whether your injuries are causally related to the motor accident
The assessor’s decision is usually binding on both parties unless successfully appealed to a review panel.
Key differences at a glance
Merit Review
- Purpose: Reviews insurer’s decision-making process
- Assessor: Merit Reviewer
- Evidence: Documents, correspondence, submissions
- Outcome: Merit Review Certificate
- Right of appeal: Limited to judicial review
Medical Assessment
- Purpose: Determines medical questions or impairment levels
- Assessor: SIRA-appointed medical specialist
- Evidence: Medical records, imaging, clinical examination
- Outcome: Binding medical certificate
- Right of appeal: SIRA Review panel (for errors of fact or law)
How to prepare for your review or assessment
For a Merit Review
- Request the insurer’s reasons in writing and check for errors or missing evidence.
- Organise your supporting documents such as payslips, receipts, medical notes, and rehabilitation reports.
- Draft a concise written submission explaining why the insurer’s decision is incorrect under the Act.
- Engage a lawyer to ensure your submission references the right legal provisions and time limits.
For a Medical Assessment
- Gather all medical reports and ensure your treating doctors have provided clear, detailed diagnoses.
- Be honest and specific when examined by the SIRA-appointed assessor.
- Bring your medication list, scan results, and any diaries or pain logs.
- Seek advice early as the medical assessor’s findings often determine your eligibility for long-term benefits.
Why legal advice is critical
Navigating SIRA’s dispute process can be technical and time-sensitive. Mistakes in evidence, deadlines, or documentation can limit your compensation or delay your claim.
An experienced CTP and motor accident lawyer can:
- Identify whether your dispute belongs in a Merit Review or Medical Assessment
- Prepare persuasive written submissions
- Arrange the right independent medical reports
- Represent you through SIRA’s DRS process or any subsequent appeal
If your insurer has made a decision you disagree with, or you’ve been called to a medical assessment, get advice early.