Entitlements for Family Caregivers in NSW CTP Claims Following Amputation
An amputation resulting from a motor accident in New South Wales may significantly affect the injured person’s ability to perform daily tasks, work, and maintain independence. Under the Motor Accident Injuries Act 2017 (MAIA), individuals who sustain such injuries may be entitled to compensation through the Compulsory Third Party (CTP) insurance scheme. This includes coverage for medical treatment, prosthetic devices, and long-term care needs. Family members or unpaid caregivers who provide assistance that would otherwise require paid professional care may also be eligible for a care and support benefit.
What Care and Support Benefits Are Available
A claimant may seek compensation for care provided by a family member or unpaid caregiver. This is known as a care and support benefit. The value is based on the reasonable hourly rate for equivalent professional care, as set by the Motor Accident Injuries (General) Regulation 2017. For example, if a family member spends 10 hours per week assisting with personal care, mobility, household tasks, or transportation, that time may be valued at the current market rate for a qualified care worker.
To claim these benefits, the claimant must demonstrate that the care is necessary due to the injury, that it is not already being provided by a paid professional, and that the caregiver is not receiving a payment for the same services. The claimant must also provide evidence of the time spent and the nature of the care provided. The claim must not duplicate any government payments, such as a carer payment, for the same care.
How Care and Support Is Assessed
The Motor Accident Injuries (General) Regulation 2017 and the Motor Accident Injuries Guidelines (SIRA) state that the value of care and support benefits is not based on emotional or familial relationships alone. Instead, the assessment focuses on the actual hours of care provided and the reasonable market rate for that service. Family members who are not employed and who provide care without pay may still be eligible for compensation, but the claim must be supported by detailed records.
SIRA guidelines clarify that the claimant must not be receiving a government payment (such as a carer payment) for the same care. If a family member is already receiving a government carer payment, the CTP claim for that same care may be reduced or excluded. The claimant must disclose all sources of income or support related to care, as failure to do so may result in a claim being rejected or a repayment being required.
Evidence Required to Support a Claim
To establish a claim for caregiver support, the claimant should collect and preserve the following evidence:
- A written record of the hours spent providing care, including dates, times, and tasks performed.
- A statement from the caregiver detailing their role and the nature of the assistance provided.
- Medical reports confirming the need for ongoing care due to the amputation.
- Photographs or videos showing the claimant’s functional limitations and the assistance received.
- Correspondence with the insurer, including any requests for care benefit assessments.
SIRA advises that claims for care and support benefits are assessed on a case-by-case basis. The claimant must show that the care is reasonable, necessary, and not duplicative of other support already received.
Time Limits and Procedural Requirements
A claim for compensation under the CTP scheme must generally be made within three years of the accident date, as required by the Limitation Act 1969 (NSW). For amputation injuries, which are not classified as threshold injuries under MAIA, the full range of benefits remains available beyond 52 weeks. This is because amputations are not included in the statutory definition of a threshold injury, which includes soft tissue injuries and certain psychological injuries under section 1.6 of MAIA.
Where only threshold injuries are sustained, weekly benefits and treatment and care benefits are generally limited after 52 weeks under sections 3.11 and 3.28 of MAIA. However, this restriction does not apply to amputation injuries, which are considered serious and permanent. The claimant must still notify the insurer of the injury and initiate the claim process as soon as possible to avoid delays in receiving treatment and care benefits.
When to Seek Independent Advice
The CTP claims process can be complex, particularly when family members are involved in care or when long-term prosthetic needs arise. SIRA notes that claimants may request a review of a decision if they believe the assessment of care needs or benefit amounts is incorrect. Disputes may be resolved through mediation or, if necessary, by applying to the NSW Civil and Administrative Tribunal (NCAT).
If the claimant is unsure about the value of care benefits, the need for a formal assessment, or whether a government payment affects eligibility, it is advisable to seek independent legal or financial advice. The claimant should not assume that family members’ contributions are automatically compensable or that government payments are incompatible with CTP benefits.
Next Steps
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.