What Attendant Care Services Are Covered in NSW CTP Claims
If you have suffered a serious injury in a motor accident in New South Wales, you may be entitled to claim attendant care services through your Compulsory Third Party (CTP) insurance. These services cover practical assistance with daily personal tasks such as bathing, dressing, preparing meals, managing medications, and getting in and out of bed. The CTP insurer may pay for a trained carer to provide this support, either in your home or at a care facility, if your injury prevents you from performing these tasks independently.
The Motor Accident Injuries Act 2017 and the Motor Accident Injuries Regulation 2017 set the legal framework for these claims. To qualify, the need for attendant care must be directly caused by injuries sustained in the accident and must be medically necessary. The insurer will assess whether the care is reasonable, necessary, and provided by a qualified person.
How SIRA’s Guidance Determines Eligibility for Attendant Care
The State Insurance Regulatory Authority (SIRA) provides detailed guidance on what constitutes a valid claim for attendant care. Under SIRA’s framework, eligibility depends on three core factors: medical evidence of functional impairment, a documented need for assistance with personal care, and a reasonable expectation that the care will improve or maintain your quality of life.
The insurer will not approve claims for attendant care if the need is temporary, self-managed, or provided by a family member without formal training. The care must be delivered by a registered or qualified provider, and the hours must be proportionate to your level of disability. SIRA’s Motor Accident Guidelines clarify that care must be clinically justified and not merely convenient or preferred.
Practical Examples of Attendant Care Claims in NSW
A 42-year-old man was involved in a head-on collision in Liverpool, NSW, in March 2025. He sustained a spinal cord injury that left him partially paralysed and unable to transfer from bed to a wheelchair without assistance. His treating neurologist confirmed he required daily supervision and physical support for mobility, hygiene, and medication. The CTP insurer approved 30 hours of attendant care per week, provided by a registered care worker, under a formal care plan.
In another case, a 68-year-old woman in Wollongong suffered a severe brain injury in a rear-end collision in October 2024. She developed cognitive and physical impairments that made it unsafe for her to live alone. A neuropsychiatrist documented her inability to manage her daily routine, including eating, bathing, and using the toilet independently. The insurer approved attendant care for 25 hours per week, including overnight supervision, based on a multidisciplinary care assessment.
These examples reflect SIRA’s emphasis on medical documentation and functional assessment. Claims are not approved based on preference or family availability alone.
What Evidence Supports an Attendant Care Claim?
To establish a claim, you must provide evidence that demonstrates a genuine and ongoing need for care. Key documents include:
- A medical report from your treating practitioner confirming your functional limitations and the need for assistance
- A formal care plan developed by a registered nurse, physiotherapist, or care coordinator
- A record of the care provider’s qualifications and registration
- A schedule of care hours, including start and end times, and a description of tasks performed
- Photographs or videos (if relevant and consented to) showing difficulty with daily tasks
- Correspondence with the CTP insurer, including any rejection or dispute
Insurers may request a review by an independent medical assessor if they dispute the need for care. You have the right to respond to any assessment and provide additional evidence.
Time Limits and Dispute Resolution
There is no fixed deadline for making a claim for attendant care services under NSW CTP law, but delays may affect the insurer’s ability to verify your circumstances. It is best to notify your insurer as soon as possible after the accident, particularly if care is already required.
If your claim is denied or the insurer refuses to cover a reasonable number of hours, you may request a review under the CTP scheme. You can also apply to the Civil and Administrative Tribunal (NCAT) for a determination if the dispute remains unresolved. SIRA provides a step-by-step guide on how to lodge a formal dispute.
When to Seek Independent Advice
The legal and procedural requirements for claiming attendant care services are complex. Decisions about care hours, provider qualifications, and medical documentation can significantly impact your entitlement. If you have been denied care, received a partial approval, or are unsure whether your injury qualifies, it is advisable to seek independent legal or claims advice.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.