Understanding Attendant Care Services in NSW CTP Claims
If you have sustained a serious injury in a motor accident in New South Wales, you may be entitled to claim for attendant care services. These are paid services that provide personal care and supervision when you are unable to manage daily tasks such as bathing, dressing, eating or managing medications due to your injury. Under the Motor Accident Injuries Act 2017 (MAIA), you may claim for these services if they are reasonable and necessary, and if they are directly caused by injuries from the accident.
The claim must be made within the time limits set out in NSW law. These limits are not automatic and depend on the nature of the injury, the date of the accident, and whether you have already made a claim for other benefits. The time limits are not the same for all types of claims and must be understood in context.
Legal Framework for Attendant Care Claims
The current legal framework for motor accident compensation in NSW is governed by the Motor Accident Injuries Act 2017 (MAIA), which replaced the older Motor Accidents Compensation Act 1999. The MAIA applies to all motor accidents occurring on or after 1 December 2017. For accidents before that date, different rules may apply, and the claim process may differ.
Under the MAIA, attendant care services are considered a form of treatment and care benefit. These benefits are available to people who have suffered injuries that result in a need for personal care or supervision. The claim must be made through the Compulsory Third Party (CTP) insurer of the vehicle that caused the accident. This insurer is responsible for assessing and paying valid claims for attendant care, as well as other benefits like medical treatment, weekly income payments, and, in some cases, damages.
Time Limits for Making a Claim
There is no fixed statutory time limit for making a claim for attendant care services under the MAIA. However, the claim must be made within a reasonable time after the accident, and the insurer may refuse a claim if it is made too late, particularly if the delay has caused prejudice to the insurer’s ability to investigate or assess the claim.
The SIRA (State Insurance Regulatory Authority) advises that claims should be made as soon as possible after the need for attendant care arises. Delays may affect the insurer’s ability to verify the need for services, obtain medical evidence, or assess the reasonableness of the care plan. If the claim is made more than 12 months after the accident, the insurer may require a detailed explanation for the delay, and the claim may be denied if the delay cannot be justified.
In practice, most claims for attendant care services are made within the first 6 to 12 months after the accident. This is because the need for care often becomes apparent soon after the injury, and medical practitioners typically document the need in the initial treatment period. The sooner a claim is made, the stronger the evidence base will be.
What Evidence Supports a Claim for Attendant Care?
To establish a claim for attendant care services, you must provide evidence that the care is necessary and reasonable. The following documents are commonly required:
- A medical report from your treating practitioner confirming that you are unable to perform essential daily tasks due to your injuries.
- A care plan or assessment from a qualified care provider, such as a registered nurse, occupational therapist, or community care worker, detailing the type, frequency, and duration of care required.
- Invoices or receipts for the paid attendant care services, including the name of the provider, the date of service, and the hours provided.
- A record of any informal care provided by family members, including a statement of the hours and nature of assistance given.
SIRA notes that informal care provided by family members may be considered in assessing the overall need for paid attendant care, but it is not automatically compensable. The claim must demonstrate that paid services are necessary because informal care is insufficient or unsustainable.
When a Claim May Be Disputed or Denied
An insurer may dispute a claim for attendant care services on several grounds. Common reasons include:
- The injury is not serious enough to justify paid care.
- The care is not reasonable or necessary, based on medical evidence.
- The claim is made too late, and the insurer cannot verify the need.
- The care was not provided by a registered or approved provider.
If your claim is denied or partially denied, you have the right to request a review from the insurer. If you are not satisfied with the outcome, you may apply to the Civil and Administrative Tribunal (NCAT) for a decision. You must apply within 12 months of receiving the insurer’s decision, or within 12 months of the claim being denied, whichever is later.
Hypothetical Example: A Claim for Long-Term Attendant Care
A 45-year-old man was involved in a car crash in Sydney on 15 March 2025. He sustained a spinal cord injury that left him partially paralysed and unable to transfer from bed to chair without assistance. His neurologist confirmed that he would require daily assistance with personal care for at least 12 months.
He began receiving paid attendant care from a registered provider on 10 June 2025 and submitted a claim to the CTP insurer in August 2025. The insurer accepted the claim after reviewing medical reports and care invoices. The claim was processed within 10 weeks, and payments were made for 12 months.
The man later applied for an extension of care based on a new medical assessment. The insurer rejected the extension, citing that the initial claim had been made within a reasonable timeframe and that the need for care was not expected to last beyond 12 months. The man may appeal this decision to NCAT within 12 months of the rejection.
When to Seek Legal Advice
The rules around attendant care services are complex and depend on the nature of the injury, the timing of the claim, and the evidence available. If you are unsure whether your claim is within the time limits, whether the care you received qualifies, or whether the insurer has acted fairly, it is advisable to seek independent legal advice.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.