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).
If you've been injured in a motor accident and need help with daily living tasks, you may be eligible for attendant care services under New South Wales' Compulsory Third Party (CTP) scheme. This article explains how to claim these services, what evidence is needed, and key steps to take early after an accident. The NSW CTP scheme, governed by the Motor Accident Injuries Act 2017, provides financial support for injuries caused by motor vehicle accidents, including assistance with personal care and supervision. Understanding the process is critical to securing benefits before time limits apply.
How the NSW CTP Scheme Handles Attendant Care Claims
Under the CTP scheme, you can claim attendant care services if your injury requires assistance with daily activities like eating, dressing, or mobility. This benefit is available for injuries resulting from motor vehicle accidents, including collisions with cars, trucks, buses, or motorcycles. The New South Wales government’s State Insurance Regulatory Authority (SIRA) administers these claims. To qualify, your injury must meet the definition of a 'threshold injury' under the Motor Accident Guidelines. This typically means your injury must involve a spinal nerve-root injury with neurological signs, or other specified clinical indicators. If your injury falls within this category, you may be eligible for weekly payments to cover the cost of care.
Practical Steps for Early Claiming
To start a claim for attendant care services, take the following steps immediately after an accident:
- Seek medical attention to document your injuries. A medical professional must confirm your need for care. Keep all medical records, including reports from doctors, physiotherapists, and occupational therapists.
- Report the accident to the relevant insurer. If you were a driver, passenger, or cyclist, contact the at-fault driver’s insurance company. If you are a pedestrian or cyclist, contact the insurer of the vehicle involved.
- Contact SIRA directly through their claims portal. SIRA handles claims for injuries under the CTP scheme. You can submit a claim online via the SIRA website or by phone. Be prepared to provide details about the accident, your injuries, and your need for care.
- Keep records of care costs. If you are already receiving care, retain receipts for services like home help, nursing visits, or assistance with personal hygiene. These documents will support your claim for weekly payments.
Evidence Needed for an Attendant Care Claim
SIRA requires specific evidence to assess your claim. Key documents include:
- Medical reports confirming your injury and the need for care. These should detail the nature of your injuries, the impact on your daily life, and the necessity of assistance.
- Accident reports from police or witnesses. These help establish the circumstances of the accident and confirm your involvement.
- Witness statements. If others saw the accident, their accounts can support your claim.
- Photographs of the accident scene, vehicle damage, and any visible injuries. These can help SIRA understand the severity of the incident.
- Income records. If your injury has affected your ability to work, provide evidence of lost wages. This helps determine your eligibility for weekly income payments.
Time Limits and Dispute Options
You have 52 weeks from the date of the accident to claim benefits for injuries that fall within the 'threshold injury' definition. After this period, you may no longer be eligible for weekly payments, although you may still be able to claim for treatment and care. If your injury is more severe and results in long-term or permanent impairment, you may be eligible for additional compensation. However, claims must be submitted within the applicable time limits. If you believe SIRA has made an incorrect decision, you can request a review through the NSW Civil and Administrative Tribunal (NCAT). This process allows you to challenge a decision and seek a reconsideration of your claim.
When to Seek Legal Advice
While SIRA handles most claims, complex cases may require legal assistance. A solicitor can help you navigate disputes, ensure you meet all eligibility criteria, and protect your rights. Legal advice is particularly useful if:
- Your injury involves multiple claims (e.g., both treatment benefits and weekly payments).
- You are unsure whether your injury qualifies as a 'threshold injury'.
- You are involved in a dispute with the insurer or SIRA.
- You need help with long-term care planning or compensation for future needs.
A Hypothetical Example
Consider a cyclist who was injured in a collision with a car. After the accident, they required assistance with daily tasks like eating and dressing. A doctor confirmed the need for care, and the cyclist submitted a claim to SIRA. SIRA reviewed the medical records, accident report, and witness statements. The cyclist was found eligible for weekly payments to cover the cost of care. This example illustrates how the CTP scheme supports individuals who need assistance with daily living after a motor accident.
Next Steps
Claiming attendant care services under the NSW CTP scheme requires prompt action and accurate documentation. If you are unsure about your eligibility or need help with the claims process, seek guidance from SIRA or a qualified solicitor. Every claim depends on its own facts, and the outcome may vary based on the circumstances of your accident. To request contact about your circumstances, complete the quick, no obligation enquiry form.