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).
Under NSW Compulsory Third Party (CTP) insurance, claimants who require attendant care services after a motor accident may be eligible for funding to cover treatment costs. This includes assistance with daily living tasks like dressing, eating, or mobility support. The funding is determined by the New South Wales Motor Accident Injuries Act 2017 and administered by the State Insurance Regulatory Authority (SIRA). This article explains how CTP insurers assess funding for attendant care in the Newcastle and Hunter regions, the evidence required, and practical steps for claimants.
How CTP Funding Works for Attendant Care
CTP insurers fund treatment costs, including attendant care, based on the nature of the injury and medical evidence. Under the Motor Accident Injuries Act 2017, claimants may receive weekly income payments, treatment and care benefits, or lump sum damages depending on the injury's severity. Attendant care funding is typically available for injuries requiring ongoing assistance, such as after a serious road accident resulting in spinal or neurological damage.
SIRA guidelines state that treatment costs must be directly related to the accident. For example, if a claimant needs a carer to assist with mobility exercises prescribed by a physiotherapist, the cost of those services may be funded. However, insurers will assess whether the care is 'reasonably necessary' and 'directly related' to the injury, as outlined in SIRA's What you can claim guidance.
Evidence Required for Treatment Cost Claims
To support a claim for attendant care funding, claimants must provide:
- Medical records confirming the need for assistance (e.g., a doctor's note stating mobility limitations)
- A detailed treatment plan from a registered medical practitioner
- Receipts or invoices for care services (e.g., from a registered carer or home help agency)
- Evidence of the accident, such as police reports or witness statements
In the Newcastle and Hunter regions, claimants should ensure all documentation is submitted to their insurer within 52 weeks of the accident, as weekly benefits for threshold injuries typically cease after this period under the Motor Accident Injuries Act 2017 s 4.4.
Disputes and When to Seek Advice
If an insurer refuses funding for attendant care, claimants may request a review under the Motor Accident Injuries Regulation 2017. Disputes often arise when insurers dispute the necessity of care or claim the injury does not meet the 'threshold injury' definition. For example, a claimant who suffered a soft-tissue injury without neurological signs might not qualify for ongoing care funding.
In cases where a claimant requires long-term assistance, such as after a traumatic brain injury, it may be necessary to seek independent legal advice. This is particularly important if the claimant is unsure whether their injury meets the criteria for weekly benefits or if the insurer is delaying payment.
Practical Example
Consider a cyclist in Newcastle who suffered a spinal injury after a collision. Their doctor prescribed daily physiotherapy and recommended the use of a carer to assist with exercises. The claimant submitted medical records and invoices for the carer's services. The insurer approved funding for the treatment costs but denied weekly benefits, arguing the injury did not meet the threshold. The claimant then sought a review, which confirmed the injury qualified for care funding under SIRA guidelines.
Next Steps
CTP funding for attendant care depends on the injury's nature, medical evidence, and adherence to statutory deadlines. Claimants in Newcastle and Hunter should act promptly to submit documentation and challenge any refusal of funding. For personalized advice, complete the quick, no obligation enquiry form to request contact about your circumstances.