Attendant care services, what changed after 2017 reforms (NSW-wide)
The 2017 reforms to NSW Compulsory Third Party (CTP) motor accident compensation introduced significant changes to how attendant care services are assessed and funded. These reforms, aligned with SIRA’s updated guidelines, shifted the focus from subjective assessments to a structured, evidence-based approach. If you or a loved one require ongoing care following a serious road injury, understanding these changes is critical to securing appropriate support.
The NSW CTP rules that sit behind this question
Under the Motor Accident Injuries Act 2017, claims for attendant care services are now governed by the SIRA Motor Accident Guidelines, which outline specific criteria for determining eligibility and funding. Key changes include:
- Evidence-based assessment: Claimants must provide medical documentation (e.g., reports from treating practitioners) to prove their need for care. Subjective claims are less likely to succeed.
- Defined care categories: Attendant care is limited to assistance with daily living tasks (e.g., dressing, eating) and not for general supervision. Claims for non-essential care (e.g., social activities) are typically denied.
- Funding limits: Weekly income payments and treatment benefits are generally capped after 52 weeks unless the claimant has a whole-person impairment rating of 10% or more.
These reforms aim to ensure that only those with genuine, medically substantiated care needs receive funding. For example, a claimant with a spinal injury requiring assistance with mobility would need a doctor’s report confirming this need.
Practical steps and evidence that usually matter
To support a claim for attendant care services, claimants should:
- Document care needs: Obtain medical records from treating practitioners detailing the nature and extent of the injury, and how it impacts daily living.
- Keep records of care: Maintain logs of how many hours of assistance were required, including dates and descriptions of tasks performed.
- Communicate with insurers: Submit all evidence promptly to the at-fault driver’s insurer. Delays may jeopardize claims under the 52-week statutory benefit limit.
- Challenge denials: If an insurer rejects a claim, request a review and provide additional evidence. SIRA’s guidelines outline the process for disputing decisions.
For instance, a claimant who requires assistance with personal hygiene after a traumatic brain injury must show a direct link between the injury and the need for care. A doctor’s note confirming this connection is essential.
Time limits, disputes and when to seek advice
Claims for attendant care services must be made within 52 weeks of the accident if the injury is classified as a 'threshold injury' (i.e., a soft tissue injury with no whole-person impairment). For more severe injuries, the 52-week limit does not apply, but claims must still be submitted within a reasonable timeframe.
If an insurer disputes a claim, claimants should:
- Review SIRA’s guidelines to ensure their evidence meets the required standards.
- Seek independent medical opinions if the insurer’s assessment is unclear.
- Consult a legal professional if disputes escalate, as the 2017 reforms do not provide a clear pathway for resolving complex disputes.
The reforms also clarify that attendant care is not automatically funded for all serious injuries. A whole-person impairment assessment by a qualified medical practitioner is now required to qualify for long-term funding.
Conclusion
The 2017 NSW CTP reforms have significantly altered how attendant care services are assessed, placing greater emphasis on medical evidence and defined care categories. Claimants must now demonstrate a clear, documented link between their injury and care needs. If you’re unsure whether your claim meets the new criteria, complete the quick, no obligation enquiry form to request contact about your circumstances.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.