What Attendant Care Services Are Covered Under NSW CTP Funding
If you have sustained a serious injury in a motor accident in Greater Sydney, you may be entitled to funding for attendant care services under the Compulsory Third Party (CTP) insurance scheme. These services include personal care such as help with bathing, dressing, eating and mobility, as well as supervision and support for daily living tasks. The CTP scheme, governed by the Motor Accident Injuries Act 2017, provides funding for these services when they are necessary due to injuries sustained in a motor accident and are not otherwise available from family, friends or government support.
Funding is not automatic. It must be assessed as reasonable, necessary and directly related to injuries resulting from the accident. The services must be provided by a qualified carer, and the need must be supported by medical evidence. This includes care required because of a permanent or long-term injury, such as spinal cord injury, traumatic brain injury, or severe musculoskeletal damage.
How SIRA Determines Eligibility for Treatment Cost Funding
The State Insurance Regulatory Authority (SIRA) administers CTP claims in NSW and determines eligibility for funding of attendant care services as part of treatment and care benefits. To qualify, the claimant must demonstrate that the care is required as a result of injuries from the motor accident and that the care is not reasonably available from informal sources.
SIRA assesses eligibility based on the Motor Accident Injuries Regulation 2017 and the Motor Accident Injuries Guidelines. These documents state that attendant care must be clinically necessary and documented by a medical practitioner. The care must be provided by a registered provider or a person who has appropriate qualifications and experience in personal care or disability support.
Funding is not provided for care that is purely for convenience or comfort. It must be for a functional need arising from the injury. For example, if you require assistance to transfer from a bed to a wheelchair due to limited mobility from a spinal injury, that may be funded. If the care is for companionship or emotional support without a functional need, it will not be funded.
Practical Steps to Include Attendant Care in Your CTP Claim
To access funding for attendant care services in Greater Sydney, you must take the following steps:
- Obtain a medical certificate from your treating medical practitioner confirming the need for attendant care due to injuries from the motor accident.
- Provide a detailed care plan outlining the type of care needed, frequency (e.g., 3 hours per day, 5 days per week), and duration.
- Submit a formal claim to the CTP insurer (usually the insurer listed on your green slip) through SIRA’s online claims portal or by completing a claim form.
- Include evidence such as a care provider’s invoice, a service agreement, or a letter from the care provider confirming the services were delivered.
- Keep all records of care received, including signed timesheets, correspondence, and payment records.
SIRA requires that care services be provided by a registered provider or a person with a formal qualification in personal care or disability support. Services provided by family members may be funded only if they are not otherwise available and if the claimant can demonstrate that informal care is not viable.
Time Limits and Dispute Options
There is no fixed deadline for making a claim for attendant care services under the CTP scheme, but it is advisable to submit your claim as soon as possible after the accident. Delays may affect the availability of evidence or the ability to verify the need for care.
If your claim for attendant care funding is denied, you may request a review from the insurer. If the review is unsuccessful, you may apply to the NSW Civil and Administrative Tribunal (NCAT) for a determination. SIRA provides guidance on the review process and how to submit an application to NCAT.
A common issue in Greater Sydney is the location of the accident. While the accident occurred in a private driveway, car park, or residential area, SIRA will assess whether the vehicle was being used in a way that constitutes a motor accident under the Motor Accident Injuries Act 2017. The legal character of the location and the use of the vehicle at the time of the incident may affect whether the claim is accepted.
When to Seek Independent Advice
The assessment of whether attendant care services are eligible for funding under CTP depends on the nature and severity of your injuries, the medical evidence, and how the claim is presented. If you have a complex injury such as a traumatic brain injury, spinal injury, or severe orthopaedic damage, it is advisable to seek independent legal advice to ensure your claim is properly documented and submitted.
A realistic example: A 42-year-old cyclist in Sydney’s Inner West was struck by a car while riding on a shared path. He sustained a spinal cord injury and now requires assistance with daily tasks, including transferring from bed, using the toilet, and preparing meals. His treating neurologist confirmed he needs 4 hours of personal care per day. He submitted a claim for attendant care funding through SIRA, supported by a care plan, medical reports, and provider invoices. The insurer approved funding for 3 hours per day, and he successfully appealed the shortfall to NCAT.
Next Steps
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.