How SIRA Defines Attendant Care Services for CTP Claims
Where a person's only injuries resulting from the accident are threshold injuries, weekly benefits and treatment and care generally cease after 52 weeks (ss 3.11 and 3.28).
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 New South Wales' Compulsory Third Party (CTP) scheme, 'attendant care services' refer to paid care and supervision required after a serious motor vehicle accident. The State Insurance Regulatory Authority (SIRA) outlines that these services are available to claimants with injuries severe enough to necessitate assistance with daily living tasks. For example, a person who cannot walk or dress themselves may qualify for support.
SIRA's rules state that attendant care is not a standalone benefit but part of a broader assessment of a claimant's needs. It is typically available when injuries meet the 'threshold injury' criteria under the Motor Accident Injuries Act 2017. This means the injury must be serious enough to result in a whole person impairment (WPI) of 10% or more, or involve a spinal nerve-root injury with neurological signs.
Documentation Required for Attendant Care Claims on the Central Coast
To claim attendant care services, claimants must provide evidence of their need for support. This includes:
- Medical records confirming the injury's severity and impact on daily activities
- A care plan from a registered nurse or physiotherapist outlining the type and frequency of assistance required
- Proof of the care provider's qualifications and the service's cost
- Any correspondence with SIRA or the insurer detailing the claim
On the Central Coast, claimants should contact SIRA directly to confirm local procedures. While SIRA's national guidelines apply, regional offices may have specific requirements for documentation or service approvals.
How SIRA's Rules Differ from Other NSW Regions
SIRA's rules for attendant care are consistent across NSW, including the Central Coast. However, local offices may handle claims differently. For instance, some areas might require additional forms or have different processing times. Claimants should always confirm procedures with their local SIRA office rather than assuming regional differences.
Practical Steps for Claimants
- Seek immediate medical attention to document the injury's impact on daily living.
- Contact SIRA within the 52-week statutory period for claims related to threshold injuries.
- Submit a detailed care plan from a medical professional, including evidence of the need for assistance.
- Keep records of all communications with insurers, including dates and summaries of discussions.
- Review claims regularly to ensure benefits align with the injury's current severity.
Time Limits and Dispute Resolution
CTP claims must be submitted within 52 weeks of the accident for injuries meeting the threshold criteria. If a claimant's injuries are not threshold injuries, they may still pursue a common law damages claim, but this requires separate legal action.
Disputes over attendant care services can be resolved through SIRA's internal review process. Claimants should request a review in writing, citing specific sections of the Motor Accident Injuries Act 2017, such as Section 4.4, which outlines limitations for non-threshold injuries.
When to Seek Legal Advice
Claimants should consult a solicitor if:
- SIRA denies a claim despite medical evidence of need
- The care provider's fees are disputed
- The claimant's injuries worsen, requiring additional services
- The 52-week deadline for threshold claims is approaching
A lawyer can help navigate SIRA's rules and ensure claimants receive all entitled benefits.
Final Steps for Claimants
Understanding SIRA's rules on the Central Coast is crucial for claimants seeking attendant care services. By gathering the right evidence and following the correct procedures, injured individuals can access the support they need. For personalized guidance, complete the quick, no obligation enquiry form to request contact about your circumstances.