If your CTP insurer denies your claim or refuses to pay out the compensation you believe you're entitled to, you still have a range of options to challenge their decision under Queensland law.
It’s important that you understand how Queensland's CTP dispute process works, as it could be the difference between a successful outcome and missing out on the compensation you deserve.
This handy guide will explain:
- What to do when the insurer denies liability or disputes your claim
- How to challenge treatment funding decisions
- When and how disputes are resolved through the Compulsory Conference process
- When you may need to take the matter to court
What is a CTP Denial?
If your CTP is denied, it means your insurer has decided not to accept liability for your claim or has refused to pay for certain aspects of your compensation or treatment. Under the Motor Accident Insurance Act 1994 (Qld), insurers are obligated to make a liability decision within 6 months of receiving a correctly filled out claim form.
Common types of denials:
- Complete liability denial: the insurer claims their driver wasn't at fault for the accident
- Partial liability: the insurer accepts some responsibility but disputes the percentage of fault
- Treatment refusal: the insurer won't fund specific rehabilitation or treatment, claiming it's not "reasonable and appropriate"
- Disputed compensation: the insurer offers significantly less than you believe your losses warrant
Important: Queensland operates under a fault-based CTP scheme. This means that even if you were partially at fault for an accident, you are still able to make a claim for compensation. However your payout will be reduced by your percentage of fault, although you can recover damages if you weren't 100% responsible for the motor vehicle accident.
What to Do When Your Claim is Denied
Step 1: Get Clear Written Reasons
Your insurer should provide you with a clear explanation of the reason they have denied liability or refused to fund treatment. If you have only received a verbal explanation, request formal written reasons which explain specifically why they rejected your claim or refused payment.
Step 2: Gather Supporting Evidence
Before challenging the decision, you should collect a range of evidence to strengthen your position, including:
- Medical reports linking your injuries to the accident
- Police reports and accident documentation
- Witness statements
- Photographs from the accident scene
- Dashcam or CCTV footage (if available)
- Financial records showing your losses (payslips, receipts, invoices, etc.)
Step 3: Understand Your Options Based on the Type of Dispute
In Queensland, you have several pathways depending on whether you're disputing liability, treatment funding or the value of your claim.
Challenging Different Types of Denials
If the Insurer Denies Liability
In the event an insurer either denies that their driver was at fault or claims you were entirely at fault, it will lead to a liability dispute. In Queensland, liability disputes that cannot be resolved through negotiation are addressed at a Compulsory Conference or, if necessary, through court proceedings.
How to challenge a denial of liability:
- Gather independent evidence supporting your version of events, such as police reports, witness statements, dashcam footage, CCTV, photographs, etc.
- Get expert reports if needed (for example, an accident reconstruction expert for complex disputes)
- Your lawyer will present this evidence during negotiations and at the Compulsory Conference
- If the matter cannot be resolved, court proceedings may be necessary
Remember: it’s common for insurers to attribute more fault to claimants than is justified by the evidence. Don't accept their assessment without challenging it if you believe it to be inaccurate.
If Treatment or Rehabilitation is Denied
If an insurer refuses to fund treatment because it's not "reasonable and appropriate," you have several options under Queensland law.
How to challenge:
- Ask for an internal review. Request that the insurer refer the matter to their internal dispute resolution service
- Get supporting medical evidence. Obtain a detailed letter from your treating doctor explaining why the treatment is medically necessary and appropriate for your injuries
- Reference MAIC guidelines. Cite the MAIC rehabilitation guidelines that support the treatment
- Apply for MAIC mediation. If the dispute cannot be resolved through direct negotiation, you can apply to the Motor Accident Insurance Commission (MAIC) to appoint a mediator
- Court application. If mediation fails, either party can apply to the court to decide what rehabilitation is reasonable and appropriate
Important: if liability is denied entirely, you are usually responsible for your own treatment costs until liability is established. You may be reimbursed if it's later determined the insurer is liable, and you should explore claiming costs through Medicare, private health insurance or other personal injury insurance in the meantime.
If the Settlement Offer Seems Too Low
It’s common for initial settlement offers to be significantly lower than what claimants are actually entitled to as insurers know that many people don't fully understand their entitlements.
How to challenge a low offer:
- Get independent legal advice. Engage a CTP lawyer so they can assess whether the offer reflects your actual losses
- Obtain comprehensive medical assessments. Document your current condition, prognosis and ongoing treatment needs
- Calculate all economic losses. Include all lost wages, the impact on your future earning capacity, any out-of-pocket expenses, superannuation losses and future care needs
- Don't accept the first offer. You are not obligated to accept the insurer's initial offer
Most successful claims will involve some negotiation. The Compulsory Conference process is specifically designed to give both parties the opportunity to reach a fair settlement before resorting to court proceedings.
If You Lodged Your Claim Late
The Notice of Accident Claim Form must be lodged within 9 months of the accident (or within 1 month of consulting a lawyer, whichever is earlier), although late claims can still be accepted if you have a "reasonable excuse" for the delay.
Reasonable excuses may include:
- Being hospitalised or incapacitated due to your injuries
- Traumatic brain injury or cognitive impairment
- Not immediately realising the severity of your injuries
- Other circumstances that prevented you from lodging on time
How to challenge:
- Document your circumstances with detailed, up to date medical records which prove you had valid reasons for the delay
- Provide a written explanation of the reasonable excuse with your late claim
- Seek legal advice, as late claims can be complex
Important: you must still commence court proceedings within 3 years of the accident date, even if you have a reasonable excuse for lodging your claim late.
If the Insurer Says Your Injuries Aren't Serious Enough
Queensland's CTP scheme has no minimum injury threshold for claiming treatment costs and rehabilitation. Even a soft tissue injury can qualify for reasonable and appropriate treatment funding.
How to challenge:
- Clarify exactly what you're claiming: you don’t need to have a serious injury to claim treatment and rehabilitation costs
- Get specialist reports: these should document the full impact of your injuries and any functional limitations they cause
- Document how your injuries affect your daily life: work capacity and ability to perform household tasks are important here
Don't let insurers dismiss genuine injuries as "minor" without a proper medical assessment.
The Compulsory Conference Process
All personal injury claims in Queensland (including CTP claims) must go through a Compulsory Conference before court proceedings can be commenced. This is a mandatory settlement meeting designed to resolve claims without the need for litigation.
What happens at a Compulsory Conference:
- Both parties attend: you, your legal team and the insurer's representatives
- Presentations are made: your barrister presents your case, explaining liability and quantifying your damages. The insurer then responds
- Negotiations occur: both parties may move to separate rooms while lawyers negotiate
- Settlement or final offers: if a settlement is reached, the claim is resolved. If not, both parties exchange Mandatory Final Offers
If the Compulsory Conference doesn't resolve your claim:
- Both parties must exchange Mandatory Final Offers, which remain open for 14 days
- You have 60 days after the Compulsory Conference to commence court proceedings
- These final offers have cost implications. If you do better at trial than your final offer, you may achieve a cost order in your favour
Success rate: the vast majority of CTP claims in Queensland are settled without going to trial at or after the Compulsory Conference.
The Nominal Defendant: Uninsured or Unidentified Vehicles
If the at-fault vehicle involved in your incident was unregistered, uninsured or is unable to be identified (such as in a hit-and-run), you can still claim through Queensland's Nominal Defendant scheme, which is managed by MAIC.
What to do:
- File a police report immediately: this is essential for Nominal Defendant claims
- Check registration: verify whether the vehicle was actually registered using MAIC's online search option
- Lodge your claim promptly: claims against the Nominal Defendant must be lodged within 3 months of the accident (extendable to 9 months with a reasonable excuse, but no longer than that)
- Gather strong evidence: these claims have strict evidence requirements, so witness statements and any identifying information are crucial
Warning Signs and Common Mistakes
You should act immediately if:
- You're approaching any sort of deadline as missing them can seriously affect your rights
- The insurer wants a recorded statement without you having legal advice, as these can be used against you in the future
- The insurer is pressuring you to accept an offer quickly, as legitimate settlements don't require rushed decisions
- Treatment funding stops abruptly without proper explanation, as they can be costly and will likely come at a sensitive time
Avoid these mistakes:
- Missing the 9-month deadline. Put it in your calendar immediately after your accident
- Missing the 3-year limitation period. You must begin court proceedings within 3 years, even if negotiations are ongoing
- Accepting the first offer. It’s common for initial offers to be far below fair value
- Stopping treatment because of a denial. Any gaps in treatment can weaken your case
- Providing inconsistent information. Any and all contradictions can, and likely will, be used to dispute your injuries
- Not seeking legal advice. Most injured claimants seek legal representation, and for good reason
When to Get Legal Help
You should always seek legal advice as early as possible, especially if:
- The insurer has denied liability
- Funding for your treatment has been refused
- The settlement offer seems low
- Your injuries are serious or permanent
- The accident involved complex fault issues
- You're approaching any deadline
- The at-fault vehicle was unregistered or unidentified
Why early advice matters:
Many people don't realise they're entitled to future treatment costs, economic loss compensation, lost superannuation, domestic assistance and a range of other benefits beyond just basic medical expenses.
Seeking legal guidance as early as possible helps prevent:
- Statements or recorded interviews that insurers may use against you
- Treatment gaps that weaken your claim
- Missing critical deadlines
- Accepting an inadequate settlement
Important: legal fees for CTP claims made in Queensland are strictly regulated, and many lawyers offer "no win, no fee" arrangements. It's important to understand exactly what fees will be charged from any settlement, so make sure you do your research.
Key Points to Remember
- Queensland does not have a Personal Injury Commission, disputes are resolved through negotiation, mediation (for treatment disputes), Compulsory Conference and court
- You have 9 months to lodge your Notice of Accident Claim Form (or 1 month after consulting a lawyer)
- The insurer must make a liability decision within 6 months
- You have 3 years from the accident to commence court proceedings
- Treatment disputes can be escalated through the insurer's internal process, then MAIC mediation and, if necessary, court
- Liability disputes are resolved at the Compulsory Conference or in court
- Around 99% of claims settle without going to trial
- Even if you’re partially fault, it doesn't prevent you from claiming compensation
- You can claim against the Nominal Defendant if the at-fault vehicle was uninsured or unidentified
Get Help Now
If your CTP claim has been denied or the insurer won't pay what you believe you're entitled to, getting early legal advice is crucial as it helps you understand your options, gather the right evidence and protect your rights before critical deadlines expire.
Contact Smith's Lawyers today. Call 1800 960 482 for a free, no-obligation consultation about your CTP claim
There are no upfront costs and we operate on a No Win, No Fee, No Catch® basis.
Our team is intimately familiar with Queensland's CTP scheme and handles motor vehicle accident claims, common law claims and TPD superannuation claims Australia-wide
