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Resolving disputes under the Motor Accidents Compensation Act Dispute Resolution Service (for accidents after 1 December 2017)

The DRS has replaced the Medical Assessment Service (MAS) and Claims Assessment Resolution Service (CARS).

Under the new legislation, the DRS will handle all disputes in relation to:

  1. Merit review
  2. Medical assessment
  3. Claims assessment

If you need help with the dispute resolution services under the Motor Accidents Compensation Act, please contact us today.

Merit Review

If a claimant has a dispute with the CTP insurer in relation to a determination made on the claim the claimant must request that the insurer undertake an internal review of their decision.

If the insurer has provided an internal review and has made a determination that the claimant does not agree with, or failed to notify the claimant of the outcome of the review within the specified time frame, or has denied the claimant an internal review the claimant may make an application for a merit review by DRS.

An application for merit review must be made within 28 days of receiving the insurers decision, or if no internal review was made, within 28 days of the end of the period in which the internal review ought to have been made.

Please note, it is not possible to make a request for DRS merit review without first requesting the insurer undertake an internal review. DRS time frames are strict and late applications may not be accepted. You should consult your specialist lawyer for assistance completing your application for DRS merit review.

Once a reply is received by the DRS they will arrange the merit review and assign a merit reviewer. The merit reviewer will provide reasons within 28 days of receiving the complete application.

A claimant or insurer may request the merit review decision be reviewed by a DRS review panel. This application must be made within 21 days of the date of the initial merit review decision.

Medical Assessment

The claimant may make an application for medical assessment by DRS If there is a dispute between the claimant and the insurer in relation to:

  1. Permanent impairment (E.g. level of whole person impairment)
  2. Whether care is reasonably necessary
  3. Whether treatment and care are related to an injury
  4. Whether treatment and care will improve recovery
  5. The degree of earning capacity impairment
  6. Whether the injury sustained is a “minor injury”

However, to be eligible to make a DRS medical assessment application, the claimant must first ask the insurer to conduct an internal review of their decision.

If the insurer has provided an internal review and has made a determination that the claimant does not agree with or failed to notify the claimant of the outcome of the review within the specified time frame, or has denied the claimant an internal review, the claimant can make an application for a medical assessment by DRS to resolve the medical dispute.

How to make an application

The claimant must make the application for medical assessment by DRS within 28 days of receiving the insurers internal review decision or if no internal review was made, within 28 days of the end of the period in which the internal review ought to have been made. DRS time frames are strict and late applications may not be accepted.

Once the claimant makes an application for medical assessment, the insurer has 14 days to reply, except for disputes concerning non-binding opinion medical assessments where the insurer has seven days to reply.

If the insurer does not reply within the stipulated time frame DRS may make a decision without the reply.

The matter will then be assigned to one or more medical assessors. The medical assessment may be on the papers, via tele-conference/video conference, face to face meeting, or by way of medical examination.

Determination of medical assessment

The DRA medical assessor will provide their certificate as soon as practicable, but ideally within 14 days of the client being medically examined, or if no examination, within 14 days of the assessor completing the assessment. However, in some cases the assessor may take longer to provide their certificate.

If there is an obvious error in the certificate either party may request that the assessor corrects the mistake in the certificate.

Once the insurer receives the medical assessment certificate they must inform the claimant of how and when the insurer will give effect to the medical assessment decision as well as the impact of the assessment decision on their claim.

Further medical assessment

A medical assessment conducted by DRS may be referred for another medical assessment if the injury has deteriorated or if there is additional information about the injury. For example, if a claimant was examined as having under 10% whole person impairment, and their condition deteriorated after the initial assessment, the claimant could then make a DRS application for further assessment in the hope of gaining a whole person impairment assessment of over 10%.

Applications for further medical assessment may be brought at any time. However, only one further medical assessment can be made. Therefore, if a claimant’s condition is deteriorating it is important to make sure that the condition has stabilised, and will not get worse, and there will not be a need for surgery in the future. If surgery is required, it is advised that the further medical assessment be postponed until surgery is complete and the medical condition has stabilised.

As a further medical assessment is the last opportunity to be assessed it is important that the claimant discuss their condition with their lawyer, as well as their relevant medical specialists.

Review of medical assessment certificates

Either party may request that the DRS review a single medical assessment by with a single medical assessor or by a review panel if they believe the decision is incorrect in a material respect. Application for a medical assessment review must be made within 28 days of receiving the certificate of the single medical assessor, and only one review may be made of a medical assessment certificate.

Once the application for review is made, a reply may be lodged by the respondent within 14 days of receiving the application. If the reply is late or does not comply with the rules DRS may decline the reply and make a determination without it.

The DRS will review the application, and reply (if applicable) and make a determination as to whether the initial medical assessment was incorrect in a material respect. The matter will then be assigned to a panel of at least two medical assessors. It is possible that the review may include an additional medical examination.

The appeal panel may accept further material that was not available at the initial medical assessment, however it will conduct the review by way of new assessment of all the mattersin question. A claimant wishing to have new material assessed at the review should discuss with their lawyer any implications that this may have on their case.

The review panel will provide their review certificate as soon as practicable, but ideally within 28 days of the review assessment.

Claims Assessment

The claimant may refer a matter to DRS if it is in relation to:

  1. Damages settlement approval
  2. Miscellaneous claims assessment
  3. Damages claims assessment
  4. Further damages claims assessment

Damages settlement approval

If a claimant is not legally represented, the claimant will need to obtain approval from DRS before they can settle their case.

Miscellaneous claims assessment

Miscellaneous disputes include disputes in relation to:

  • Whether the death or injury has resulted from a motor accident in the state of NSW
  • Whether the motor accident concerned was caused by the fault of another person
  • Whether the motor accident was caused by the injured person (contributory negligence)
  • Whether the claimant has suffered minor injuries and is not entitled to statutory benefits after 26 weeks of the date of accident
  • Whether a serious driving offence was committed (no statutory benefits)
  • Whether the claimant has given full and satisfactory response for non-compliance with a duty or for a delay (E.g. not making a claim within the statutory time frame or not reporting the accident to the police within the statutory time frame)
  • Whether the motor accident verification requirements have been complied with

How to make an application:

In order to refer the dispute to the DRS for miscellaneous claims assessment the claimant must first ask the insurer to conduct an internal review of their decision.

If the insurer has provided an internal review and has made a determination that the claimant does not agree with, or failed to notify the claimant of the outcome of the review within the specified time frame, or has denied the claimant an internal review, the claimant can make an application for a miscellaneous claims assessment by DRS to resolve the dispute.

An application for merit review must be made within 28 days of receiving the insurers decision, or if no internal review was made, within 28 days of the end of the period in which the internal review ought to have been made.

The respondent may reply to the application for miscellaneous assessment within seven days for statutory benefit disputes, 14 days for procedural disputes, and 21 days for fault and contributory negligence disputes.

If the respondent does not reply within the stipulated time frame DRS may make a decision without their reply.

The dispute will then be assigned to a dispute resolution officer who will contact all parties and arrange an assessment. The assessment may be on the papers, tele-conferences and video conferences, or face-to-face meetings.

Determination of miscellaneous dispute assessment

The assessor will make a determination as soon as practicable but preferably within seven days of the assessment. The assessor will provide both parties with a certificate and brief statement of reasons for the determination. Either party may request that an obvious error be corrected in the certificate.

Once the insurer receives the medical assessment certificate they must inform the claimant of how and when the insurer will give effect to the dispute assessment decision as well as the impact of the assessment decision on their claim.

Damages claims assessment

Both the claimant and the insurer may refer a claim for damages to the DRS for assessment of pain and suffering and past and future economic loss.

To have damages claims assessed by DRS the claimant must make a claim for common law damages within two years of the date of accident, and the application for claims assessment with DRS must be made within three years of the date of accident.

Further damages claims assessment

Both the claimant and the insurer may refer a claim for damages to the DRS for a further claims assessment where there is significant new evidence produced in court proceedings after a claims assessor has previously assessed a claim.

If you need help with the dispute resolution services under the Motor Accidents Compensation Act, please contact us today.

Garling & Co Lawyers

Matthew Garling

Matthew Garling is an Accredited Specialist in Personal Injury Law approved by New South Wales Law Society. He is admitted to practice in the Supreme Court of NSW and the High Court of Australia. Matthew is also a member of...
Kimberly B.
23:14 14 Feb 24
Mathew is very knowledgable and has been of great assistance to me. All the staff are friendly and helpful. I'm so happy I found this firm.Thank you Mathew and team for your great work in my case.... I am 100% happy with what you achieved for me.read more
Julie M.
10:16 16 Jan 24
My last stage of Workers compensation claim was managed by Emma Perkins, Natasha Stojanovic, Rebecca Dunshea and Kelli Robinson at Garling and Co. Lawyers who went the extra mile with their service... from the beginning to the end of 3 years of my case. I have become very anxious with almost everything after a workplace injury and a lot of times I probably ask more questions than I need to, but Emma Perkins always finds clear answers to my questions in a short time and explains to me patiently even using her mealtime or between her meeting and make me feel that I have been very well take care and supported. I am so grateful and extremely satisfied. The excellent service, attitude, and culture of Metthew Garling and his team are second to none with a very high success rate. If you going to battle with your workplace injury for a short or long period, you are better off with Garling and Co. lawyers who are able back you up every step of the way. I strongly recommend it to anybody who needs their service like me. Julieread more
patrick P.
01:46 19 Dec 23
I like to say that I had a very wonderful experience,And the support, and also understanding with all my requests,I could not ask for a better team!Thank you Emma and also her assistant Rebecca... thank youread more
Kazi H.
13:38 13 Dec 23
Work cover fund is GOVT’S money but insurer think that it is from their 14th generation. So only they can have it. Not only that, people from the work, IME doctor from insurer, back to work... coordinator from work, Rehab provider from any side push the worker as hard as possible that the worker (doesn’t matter how the workers mental or psychical condition) either go back to his pre injury duty or leave the job.More over on that very bumpy any difficult journey some of them only treat the worker as a MONEY MAKING MECHINE .in some point worker feels like, no rooms to breath. On that moment need someone to support legally, someone to care, someone to relive.On my case I believe that, somehow, I manage to make my God happy. That’s why God sends me to Matthew Gerling and his team Allison, Rebecca and Nathan, and all of GARLING & co Lawyers.I am not good enough in English, can’t express my gratitude.Matthew, Allison, Rebecca and Nathan, please accept my appreciation and pass it to others.read more
Carol L.
01:32 29 Nov 23
Professional, understanding and friendly
Sean G.
23:21 14 Nov 23
Matthew Garling and everyone I spoke to at Garling and Co were kind, caring and compassionate. They were sensitive to my psychological condition and were patient in explaining everything to me, so... that I clearly understood the legal process. I am exceptionally grateful for the settlement outcome that Garling and Co obtained for me. Many thanks.read more
waqas A.
08:33 13 Nov 23
Great Experience with Garling & Co. Matthew explained everything in detail during the first appointment. Allison, Nathan, Rebecca and the staff have been extremely helpful. Thank You to the team and... lawyers at Garling & Co. for making the long process easy for me and getting an excellent outcome for my compensation claim.I would highly recommend Garling & Co. Lawyersread more
Saskia L.
21:42 08 Nov 23
The world of workers compensation is long, hard and confusing, but Emma and Rebecca at Garling & Co always treated my case with kindness, respect and understanding. No question was ever silly and... they always had time to make sure I knew what would happen next and how we could best prepare. I am so thankful for their expertise and could not have chosen anyone better to represent me.read more
Antonio P.
08:46 06 Nov 23
Thank you Matthew and his team for taking care of my case couldn’t ask for a better results and couldn’t have better team to do that thank you
Julie M.
00:40 06 Nov 23
Garlic & Co Lawyers have been wonderful, supporting me through some difficult times. With their assistance, positive outcomes were achieved. Many thanks to the Team.Julie
READ ALL TESTIMONIALS

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Kimberly B.
23:14 14 Feb 24
Mathew is very knowledgable and has been of great assistance to me. All the staff are friendly and helpful. I'm so happy I found this firm.Thank you Mathew and team for your great work in my case.... I am 100% happy with what you achieved for me.read more
Julie M.
10:16 16 Jan 24
My last stage of Workers compensation claim was managed by Emma Perkins, Natasha Stojanovic, Rebecca Dunshea and Kelli Robinson at Garling and Co. Lawyers who went the extra mile with their service... from the beginning to the end of 3 years of my case. I have become very anxious with almost everything after a workplace injury and a lot of times I probably ask more questions than I need to, but Emma Perkins always finds clear answers to my questions in a short time and explains to me patiently even using her mealtime or between her meeting and make me feel that I have been very well take care and supported. I am so grateful and extremely satisfied. The excellent service, attitude, and culture of Metthew Garling and his team are second to none with a very high success rate. If you going to battle with your workplace injury for a short or long period, you are better off with Garling and Co. lawyers who are able back you up every step of the way. I strongly recommend it to anybody who needs their service like me. Julieread more
patrick P.
01:46 19 Dec 23
I like to say that I had a very wonderful experience,And the support, and also understanding with all my requests,I could not ask for a better team!Thank you Emma and also her assistant Rebecca... thank youread more
Kazi H.
13:38 13 Dec 23
Work cover fund is GOVT’S money but insurer think that it is from their 14th generation. So only they can have it. Not only that, people from the work, IME doctor from insurer, back to work... coordinator from work, Rehab provider from any side push the worker as hard as possible that the worker (doesn’t matter how the workers mental or psychical condition) either go back to his pre injury duty or leave the job.More over on that very bumpy any difficult journey some of them only treat the worker as a MONEY MAKING MECHINE .in some point worker feels like, no rooms to breath. On that moment need someone to support legally, someone to care, someone to relive.On my case I believe that, somehow, I manage to make my God happy. That’s why God sends me to Matthew Gerling and his team Allison, Rebecca and Nathan, and all of GARLING & co Lawyers.I am not good enough in English, can’t express my gratitude.Matthew, Allison, Rebecca and Nathan, please accept my appreciation and pass it to others.read more
Carol L.
01:32 29 Nov 23
Professional, understanding and friendly
Sean G.
23:21 14 Nov 23
Matthew Garling and everyone I spoke to at Garling and Co were kind, caring and compassionate. They were sensitive to my psychological condition and were patient in explaining everything to me, so... that I clearly understood the legal process. I am exceptionally grateful for the settlement outcome that Garling and Co obtained for me. Many thanks.read more
waqas A.
08:33 13 Nov 23
Great Experience with Garling & Co. Matthew explained everything in detail during the first appointment. Allison, Nathan, Rebecca and the staff have been extremely helpful. Thank You to the team and... lawyers at Garling & Co. for making the long process easy for me and getting an excellent outcome for my compensation claim.I would highly recommend Garling & Co. Lawyersread more
Saskia L.
21:42 08 Nov 23
The world of workers compensation is long, hard and confusing, but Emma and Rebecca at Garling & Co always treated my case with kindness, respect and understanding. No question was ever silly and... they always had time to make sure I knew what would happen next and how we could best prepare. I am so thankful for their expertise and could not have chosen anyone better to represent me.read more
Antonio P.
08:46 06 Nov 23
Thank you Matthew and his team for taking care of my case couldn’t ask for a better results and couldn’t have better team to do that thank you
Julie M.
00:40 06 Nov 23
Garlic & Co Lawyers have been wonderful, supporting me through some difficult times. With their assistance, positive outcomes were achieved. Many thanks to the Team.Julie
University of Technology, Sydney
Member of Law Society of New South Wales
Law Society of NSW Specialist Accreditation
University of Sydney
Legal Profession Admission Board of New South Wales
The law society of nsw professional standards scheme logo.
University of Technology, Sydney
Member of Law Society of New South Wales
Law Society of NSW Specialist Accreditation
University of Sydney
Legal Profession Admission Board of New South Wales
The law society of nsw professional standards scheme logo.
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