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).
Attendant care services are a critical part of compensation for injured people in NSW after a motor accident. However, claimants in Western Sydney often make errors that can delay or reject their claim. This article explains the most common mistakes to avoid when seeking attendant care services under the NSW Compulsory Third Party (CTP) scheme, based on SIRA guidelines and legal requirements.
What is Attendant Care Services Compensation?
Attendant care services cover assistance with daily living tasks like bathing, dressing, or meal preparation after a serious injury. Under the Motor Accident Injuries Act 2017, these services are available if the injury meets the 'threshold injury' criteria outlined in the Motor Accident Guidelines. SIRA confirms that care services are a statutory benefit, not a discretionary payment, but claimants must prove the need through medical evidence.
Common Mistakes to Avoid
- Failing to Document Care Needs: Claimants often neglect to keep records of how their injury affects daily activities. Without detailed notes from healthcare providers, insurers may dispute the necessity of care services. For example, a claimant who doesn’t track how their injury impacts bathing or mobility may lose support for attendant care.
- Missing Time Limits: The 52-week statutory benefit period applies to threshold injuries. If a claimant’s only injuries are threshold injuries, weekly benefits and care services may stop after 52 weeks. SIRA’s guidelines clarify that this applies only if the injury does not meet the whole person impairment threshold. A claimant who assumes care services last indefinitely may miss the deadline.
- Not Following SIRA’s Application Process: SIRA requires specific forms and evidence for care services. Claimants who submit incomplete applications or fail to include medical reports, care provider invoices, or a doctor’s statement on care needs risk delays. For instance, a claimant who submits a care plan without a medical professional’s endorsement may be denied.
- Ignoring Fault and Blameless Accidents: While CTP claims are typically fault-free, some cases involve blameless accidents. Claimants must ensure their application clearly states the accident’s circumstances to avoid disputes. SIRA’s 'Making a motor accident claim' page outlines how to detail the incident accurately.
- Overlooking Post-Accident Steps: After an accident, injured people should seek immediate medical attention and document the incident. Failing to report the accident to the insurer within the required timeframe (usually 14 days) can jeopardise claims. A claimant who delays reporting may lose access to care services.
How to Avoid Mistakes
To prevent errors, claimants should:
- Obtain a medical report confirming the need for attendant care.
- Submit all required SIRA forms, including the 'Application for benefits' and 'Supporting evidence' documents.
- Keep records of all care services, including invoices and provider details.
- Seek legal advice if the claim is denied or if disputes arise.
When to Seek Help
If a claimant is unsure about their entitlements or faces a dispute, contacting a solicitor specialising in NSW CTP claims can help. Legal professionals can review medical records, ensure compliance with SIRA guidelines, and challenge incorrect decisions.
Next Steps
CTP claims depend on accurate documentation, timely action, and adherence to SIRA’s rules. In Western Sydney, claimants must be aware of the 52-week limit for threshold injuries and the need for medical evidence. Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.