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).
Families in Newcastle and Hunter seeking compensation for attendant care services after a motor accident must understand how the NSW Compulsory Third Party (CTP) scheme assesses care needs. This article explains what types of care are claimable, how SIRA evaluates expenses, practical steps for families, and how to challenge decisions. The NSW CTP rules apply to all motor vehicle accidents, regardless of location, and require evidence of care needs to secure benefits.
What Types of Attendant Care Are Claimable Under NSW CTP Laws?
Under the Motor Accident Injuries Act 2017, families can claim payment for 'attendant care services' if the injured person requires assistance with daily living activities. This includes help with personal hygiene, dressing, eating, mobility, and managing household tasks. SIRA guidelines specify that care must be provided by a trained professional or a family member in a caregiving role. For example, a family member may claim reimbursement for time spent helping a loved one with personal care after a serious road injury.
How Does SIRA Assess the Need for and Cost of Attendant Care?
SIRA evaluates care needs using the Motor Accident Guidelines, which require medical evidence confirming the injury’s impact on daily living. Claims must demonstrate that the care is 'reasonably necessary' and 'reasonably required' to meet the injured person’s needs. Costs are typically limited to the market rate for similar services, and families must provide receipts or invoices to support claims. SIRA also considers the injured person’s ability to perform tasks independently and may require a care plan outlining specific needs.
Practical Steps for Families Supporting a Loved One’s CTP Claim
Families should document the injured person’s care needs through medical records, care logs, and witness statements. Keeping records of all expenses, such as transportation to appointments or home modifications, is crucial. Communication with the CTP insurer is key: families must notify the insurer of care arrangements and submit claims promptly. If the insurer disputes the need for care, families should request a written explanation and seek legal advice if necessary.
Disputing a CTP Insurer’s Decision on Attendant Care
If an insurer denies or limits care payments, families can challenge the decision by submitting additional evidence, such as a second medical opinion or proof of care costs. SIRA allows for review of claims if new information emerges, and families may also escalate disputes through mediation or formal review processes. It’s important to note that time limits apply: claims must be submitted within 52 weeks of the accident unless an extension is granted.
Example: A Family’s Experience with Attendant Care Claims
Consider a scenario where a cyclist in Newcastle suffers a spinal injury and requires round-the-clock care. The family hires a professional carer and documents all expenses. However, the insurer disputes the claim, arguing the care was not 'reasonably necessary.' The family submits medical evidence showing the injury’s impact and secures a review, leading to a successful claim. This example highlights the importance of thorough documentation and timely action.
When to Seek Legal Advice
While families can manage claims independently, complex disputes or unclear insurer decisions often require legal assistance. A solicitor can help navigate SIRA’s processes, challenge denied claims, and ensure families receive all entitled benefits. Legal advice is particularly valuable when disputes involve long-term care needs, multiple claimants, or overlapping workers’ compensation issues.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.