Map an NSW insurer decision that may rest on an automated tool
MaintainedLast reviewed
Key facts
- Human involvement
- YellowClose supervision
- How AI is used
- From the insurer's decision and reasons, list the outcome, the reasons given, any reference to an automated tool, and the review step the opened NSW pathway allows. Do not decide whether a tool was used or whether the decision is lawful.
- What the lawyer must review
- For a motor accident on or after 1 December 2017, use the internal review clock in the Guidelines
- Do not apply that clock to a workers compensation dispute
- The lawyer decides whether to challenge the decision and on what ground
- Health and claim records stay in a firm-controlled tool
Rules that apply
The document starts from the task name. Change it if this piece of work is different.
The work product
Forum. NSW motor accident insurer decision under the Motor Accident Injuries Act 2017, or a workers compensation insurer decision
Produce. A map of the decision, the reasons, and the review step that applies to that scheme.
Have ready. The insurer's decision and reasons; The date the claimant received the decision; The scheme the lawyer names.
Example of the limit. Illustrative example: A motor accident insurer denies weekly payments and gives no reason beyond a score. The map records the denial, the missing reasons and the 28-day internal review period. It does not allege that a model was used.
Stop and hand it back when
- The scheme is workers compensation and the only period on the page is the motor accident period.
- The date of receipt is not known, so the 28 days cannot be counted.
Sources for this task were checked on 2026-10-23.
Who does what
| Role | What they do |
|---|---|
| Assistance | From the insurer's decision and reasons, list the outcome, the reasons given, any reference to an automated tool, and the review step the opened NSW pathway allows. Do not decide whether a tool was used or whether the decision is lawful. |
| Lawyer | Set the scope, supervise the work closely, verify every part relied on, resolve omissions and exceptions, and approve the exact output. |
Checklist
- Record the decision, the date the claimant received it, and the reasons. Record a reference to an automated tool only if the decision or the file states one.
- For a motor accident on or after 1 December 2017, a claimant may request an internal review within 28 days of receiving notice of the decision from the insurer. The insurer may accept or decline a later request.
- Section 7.9(4) says the insurer notifies the result within 14 days after receiving the request, unless the Guidelines allow longer. Guideline 7.25 allows 21 days for the degree of permanent impairment, a threshold injury, fault, mostly at fault, a serious driving offence, or contributory negligence, and 14 days after new information is provided. Guideline 7.26 sets a maximum of 28 days after the request.
- For workers compensation, use the dispute path and the Independent Review Office. Do not import the motor accident 28-day count.
Sources
- Motor Accident Injuries Act 2017 (NSW) section 7.9 · 2026-10-23
- SIRA: Part 7 of the Motor Accident Guidelines: Dispute resolution · 2026-10-23
- SIRA: Weekly payments · 2026-10-23
No NSW statute opened for this task regulates an insurer's use of an algorithm. The task maps the decision and the review path that was opened.
If the dispute reaches the Personal Injury Commission, Procedural Direction PIC13 limits how generative AI may be used in the proceedings.