The Insurer Stopped My Weekly Payments — What Now?

Weekly payments stopping is one of the most stressful moments in a CTP claim, and it usually arrives as a letter rather than a conversation. The first thing worth knowing is that a decision is a decision, not the end of the matter — the scheme has review pathways, and they have deadlines.

This page is general information about what to do next. It is not legal advice, and it cannot tell you whether your payments should be reinstated. The rules are published by SIRA and advice about your claim belongs with a solicitor. CTP Doctor is a medical service, not a law firm, and the part we can help with is the medical record that decisions about capacity rely on.

Read the letter properly first

Decision letters are dense, but they usually contain everything you need to work out your position. Read it once for the reason, then again with a pen.

• The stated reason for the decision, in the insurer's own words — this is what any review will address.
• The date of the decision and the date payments stop or stopped, since time limits generally run from these.
• Which medical material the insurer says it relied on, including any examination arranged by them.
• What the letter says about internal review, including how to request one and by when.
• Whether the decision is about your capacity for work, about the period benefits can run, or about something else entirely.

Reasons decisions like this are commonly given

In general terms, payments are usually stopped because the insurer has formed a view about capacity, about the period for which benefits can run under the scheme rules, or about the evidence supporting your claim. Sometimes it follows an examination the insurer arranged. Sometimes it follows a certificate that certified capacity in a way you did not expect. Occasionally it follows nothing more than a gap in the file.

The reason matters because it points at the fix. A decision based on a misunderstanding of your restrictions is a different problem from a decision based on how long benefits can run, and the second is a legal question rather than a clinical one.

The medical side: certificates and capacity

Insurers make capacity decisions largely from Certificates of Fitness and treating notes. If your certificate says something broader than your real situation, or is vague about restrictions, that is what the decision is built on.

It is worth checking whether the record actually reflects you. Does the certificate describe specific functional restrictions — lifting, sitting, driving, standing, concentration, sleep — rather than a general statement? Does it match what the examination found? Have new symptoms or a new diagnosis been documented since the last certificate? Has treatment changed?

If the picture is out of date, a review appointment is the practical response. Our doctors reassess, examine, and update the certificate to match the findings — not to produce a particular result, but so the file is accurate. We also coordinate physiotherapy, psychology and exercise physiology so allied health reports and medical certificates say consistent things about the same period.

Internal review

For most insurer decisions the next formal step is internal review: the insurer reconsiders its own decision, generally within a set timeframe. Request it in writing, refer to the decision by date, and say plainly what you say is wrong with it.

Attach the material that supports the point rather than describing it. An updated certificate, a specialist letter, imaging results, or a report from your physiotherapist are more useful than a long explanation. Keep a copy of everything you send and note the date you sent it.

Decisions are sometimes changed at internal review, particularly where new medical material is provided. If it is not changed, that outcome is usually the gateway to the Personal Injury Commission, and further time limits apply.

When to get advice

Getting advice does not commit you to anything, and an initial conversation with a solicitor who does NSW motor accident work may confirm that the medical route is the right one for the moment.

• The decision concerns how long benefits can run, or refers to the way your injury has been classified.
• Internal review has been requested and the decision has been confirmed.
• The letter refers to a report from an examination arranged by the insurer that you disagree with.
• You are being asked to give a formal statement, or to sign something you do not fully understand.
• Money has stopped and you cannot wait out a long process — someone should be looking at your options now.

Where CTP Doctor fits, and what to do this week

We consult by telehealth across NSW, or in person where appropriate, and care for a motor accident injury is generally accessed through the CTP scheme rather than paid by you directly. Book a review, bring the decision letter and any recent scans or specialist correspondence, and we can get the clinical record straight.

We do not give legal advice and we do not deal with the insurer's decision itself. If you want legal help, we can introduce you to an independent solicitor — no referral fees, no arrangement between us, and the choice is entirely yours. Whichever route you take, act on the dates in that letter rather than waiting to see what happens.