Attendant Care Claims After 2017 Reforms in NSW
Where a person's only injuries resulting from the accident are threshold injuries, weekly benefits and treatment and care generally cease after 52 weeks (ss 3.11 and 3.28).
A threshold injury under the Motor Accident Injuries Act 2017 (NSW) includes a soft tissue injury and a psychological or psychiatric injury that is not a recognised psychiatric illness (adjustment disorder and acute stress disorder are the usual examples; s 1.6 and Motor Accident Guidelines Part 5).
The 2017 reforms to New South Wales’ Compulsory Third Party (CTP) scheme introduced significant changes to how attendant care services are assessed and funded. These reforms, which apply to all claims under the Motor Accident Injuries Act 2017, have particular implications for claimants in rural and remote areas where access to care services may be limited. This article explains what changed, how rural claimants are treated, and what evidence is needed to support a claim.
What Changed in Attendant Care Claims After 2017?
Prior to 2017, the assessment of attendant care services under the CTP scheme relied on a combination of medical reports and subjective evidence. The 2017 reforms introduced stricter guidelines to ensure claims are based on objective clinical assessments. Key changes include:
- Clinical assessment requirement: Attendant care claims must now be supported by evidence from a medical practitioner confirming the need for care and supervision. This includes detailed notes on the frequency, duration, and nature of the required assistance.
- Threshold injury criteria: Claims for attendant care are only available if the injury meets the threshold injury definition under the Motor Accident Guidelines. This means the injury must be serious enough to require ongoing assistance with daily living activities.
- Geographic neutrality: While the reforms do not explicitly address rural access, they require claimants to demonstrate that the care services are reasonably available in their area. This has led to increased scrutiny of claims from remote regions, where limited service availability may affect eligibility.
Practical Steps for Rural and Remote Claimants
Claimants in rural or remote NSW must take additional steps to support their attendant care claim under the revised scheme. These include:
- Obtaining a detailed medical report: A medical practitioner must document the need for care, including specific examples of activities requiring assistance (e.g., dressing, eating, mobility). The report should also address whether the injury meets the threshold injury criteria.
- Proving service availability: Claimants must show that the required care services are available in their area. This could include evidence such as:
- Local service directories
- Statements from healthcare providers
- Evidence of travel time or cost to access services
- Maintaining records of care: Keep a log of all care received, including dates, times, and the type of assistance provided. This helps demonstrate the ongoing need for services.
Time Limits and Dispute Resolution
The CTP scheme has strict time limits for making claims. Most claims must be submitted within 52 weeks of the accident, although exceptions exist for claims involving long-term injuries. For rural claimants, delays in accessing medical services or documentation may affect compliance with these deadlines.
If a claim is disputed, claimants can request a review by the NSW Civil and Administrative Tribunal (NCAT). The 2017 reforms introduced clearer procedures for challenging decisions, including the right to submit additional evidence or expert opinions.
When to Seek Legal Advice
The 2017 reforms have made the attendant care claims process more complex, particularly for rural claimants. Legal advice is recommended if:
- The injury is unclear or the medical evidence is contested
- There are disputes over the availability of care services
- The claimant is unsure whether their injury meets the threshold injury criteria
- The 52-week deadline is approaching and additional time is needed to gather evidence
Conclusion
The 2017 reforms to NSW’s CTP scheme have changed how attendant care claims are assessed, with particular challenges for rural and remote claimants. While the reforms aim to ensure claims are based on objective evidence, they also require claimants to demonstrate that care services are reasonably available in their area. If you’re in a rural or remote area and need assistance with an attendant care claim, it’s important to act quickly and seek professional advice to ensure your claim meets the new requirements.
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