What Attendant Care Services Are Covered in NSW CTP Claims
If you have sustained a serious injury in a motor accident in New South Wales, you may be entitled to attendant care services under the Compulsory Third Party (CTP) insurance scheme. These services are designed to assist you with daily living activities, such as bathing, dressing, preparing meals, managing medications, and moving around the home, when you are unable to perform them independently due to your injury. The Motor Accident Injuries Act 2017 and the Motor Accident Injuries Regulation 2017 establish the legal framework for these benefits. The services must be medically necessary and directly related to your injury. They are not intended for general household assistance or long-term care unrelated to recovery.
How SIRA Assesses the Need for Attendant Care Services
The State Insurance Regulatory Authority (SIRA) oversees the CTP scheme in NSW and provides guidance on eligibility for attendant care. SIRA’s assessment focuses on whether your injury has resulted in a substantial and ongoing need for personal care. This determination is made through a formal assessment process, typically conducted by an independent medical assessor or a SIRA-appointed case manager. The assessment considers your functional capacity, the nature and severity of your injury, and your ability to perform basic daily tasks. The need must be supported by medical evidence, including reports from your treating medical practitioners and any allied health professionals involved in your care.
Evidence Required to Support a Claim
To establish entitlement to attendant care services, you must provide documented evidence of your functional limitations. This includes:
- A detailed medical report from your treating practitioner outlining the nature of your injury and its impact on daily activities.
- A functional capacity assessment completed by a physiotherapist, occupational therapist, or other allied health professional.
- A care plan developed by a qualified health professional specifying the type, frequency, and duration of care required.
- Records of any prior care arrangements, including informal support from family or friends, to demonstrate the need for formal services.
Photographs of your home environment, if they illustrate barriers to mobility or safety concerns, may also be helpful. It is essential to preserve all correspondence with your insurer and to keep copies of all medical reports and care plans.
How Insurers Determine the Duration of Care Services
The duration of attendant care services is not fixed and is determined on a case-by-case basis. CTP insurers assess the expected recovery timeline and the likelihood of improvement over time. The services are generally provided for as long as your need for assistance persists and is expected to continue. If your condition stabilises and you regain the ability to perform daily tasks independently, the insurer may reduce or cease payments. Any reduction or cessation must be supported by updated medical evidence. You have the right to request a review of the insurer’s decision if you believe the assessment is incorrect or incomplete.
Time Limits and Procedural Requirements
There are time limits for making a claim for attendant care services. You must notify your insurer of your injury and your need for care as soon as practicable. While there is no strict deadline for submitting a claim, delays may affect the insurer’s ability to verify your circumstances and may result in a delay in the start of payments. It is advisable to notify the insurer within 28 days of the accident, as this is the timeframe within which most claims are processed. If you have not received a response within 60 days of your initial notification, you may contact SIRA for assistance.
When to Seek Independent Advice
If your claim for attendant care services is denied, or if you believe the amount or duration of services offered is insufficient, you may seek independent advice. SIRA provides information and guidance on dispute resolution processes, including formal review and, if necessary, application to the NSW Civil and Administrative Tribunal (NCAT). For example, care provided for non-injury-related reasons, such as age-related disability or long-term chronic illness, is not compensable under this scheme.
Hypothetical Example: Supporting Recovery After a Spinal Injury
A 42-year-old man was injured in a motor vehicle accident in Sydney in April 2026. He sustained a spinal injury that resulted in partial paralysis and loss of mobility. His treating neurologist confirmed he required assistance with transferring from bed to wheelchair, personal hygiene, and medication management. An occupational therapist assessed his home and recommended two hours of attendant care per day, five days a week. The CTP insurer accepted the claim and approved the services based on the medical evidence and care plan. The services were reviewed every six months to assess progress and adjust the care plan as needed.
Next Steps
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.