Understanding Care and Family Support in NSW CTP Claims
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).
If you are caring for someone injured in a motor accident in New South Wales, you may be entitled to support through the Compulsory Third Party (CTP) insurance scheme. This support can include financial assistance for unpaid care and for out-of-pocket expenses related to family caregiving. The Motor Accident Injuries Act 2017 and SIRA’s guidance set out the legal framework for these entitlements. However, entitlements depend on the nature of the injury, the level of care required, and whether the injured person is receiving treatment and care benefits under the CTP scheme.
What Support Is Available for Caregivers?
Under the CTP scheme, a caregiver may be eligible for a payment if they provide unpaid care to an injured person who requires assistance with daily personal tasks such as bathing, dressing, eating, or managing medication. This support is not automatic and must be assessed under the Motor Accident Injuries Regulation 2017.
To qualify, the injured person must have a whole person impairment (WPI) of at least 10%, or be receiving treatment and care benefits. The caregiver must provide a reasonable amount of care, and the care must be necessary because of the injury. The amount paid is not a fixed rate but is determined by the level of care required and the time spent, based on a formal assessment.
Claiming for Family-Related Expenses
Families may claim for out-of-pocket expenses incurred as a direct result of the injury and the need for care. These include costs for travel to medical appointments, home modifications, or equipment such as a shower chair or mobility aid. These expenses must be documented with receipts and must be directly related to the injury.
The claim for these expenses is made through the same CTP claim process as other benefits. The injured person or their legal representative must submit evidence such as itemised bills, proof of purchase, and a description of how the expense supports the injured person’s recovery or daily functioning.
Legal Boundaries for Family Support Claims
Family members who provide care are not automatically entitled to compensation. The law distinguishes between unpaid care provided by a family member and paid care provided by a professional. Only unpaid care that is necessary and reasonable, and that would not have occurred without the injury, may be considered.
There is no entitlement to payment for emotional or mental strain, or for time off work to care for a relative unless the caregiver is also a dependent or has a claim for lost income. The CTP scheme does not provide a separate payment for family members who are not directly caring for the injured person, even if they have been affected by the accident.
Practical Steps and Evidence That Matter
To support a claim for care or family-related expenses, gather the following evidence:
- A medical report confirming the need for assistance with daily personal tasks.
- A record of the time spent providing care, including dates and duration.
- Receipts for all out-of-pocket expenses, including travel, equipment, and home modifications.
- A written statement from the injured person or a family member outlining the nature and frequency of care provided.
If the injured person is a child, a statement from a parent or guardian describing the impact on family life and daily routines may also be helpful.
Time Limits and Dispute Options
There is a 3-year limitation period from the date of the motor accident to make a claim for care and family support under the CTP scheme. This applies to all claims, including those for unpaid care and out-of-pocket expenses.
If a claim is denied, the injured person or caregiver may request a review from the insurer. If the review is unsuccessful, a dispute may be referred to the NSW Civil and Administrative Tribunal (NCAT) under the Motor Accident Injuries Act 2017.
When to Seek Independent Advice
The CTP scheme can be complex, particularly when care needs are long-term or when the injured person has a serious or permanent impairment. Disputes over the level of care required, the reasonableness of expenses, or the eligibility of a family member to claim can arise.
Given the legal and evidentiary requirements, it is advisable to seek independent legal advice if:
- The claim for care or expenses has been denied.
- There is uncertainty about whether the care provided qualifies.
- The injured person has a high WPI or a threshold injury that may affect entitlements.
- The family has incurred significant out-of-pocket costs not covered by the insurer.
Hypothetical Example
A 68-year-old woman was injured in a car crash in Sydney in June 2024. She sustained a spinal injury and now requires assistance with bathing, dressing, and using the toilet. Her daughter, who lives with her, spends approximately 4 hours per day providing care. The daughter has not received any payment for this care. She has kept a log of care hours and has receipts for a shower chair and travel to specialist appointments. She may be eligible for a care payment under the CTP scheme, provided she applies within the 3-year time limit and submits the required evidence.
Next Steps
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.