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).
In New South Wales, injured road users can claim compensation for care and family support costs as part of their Compulsory Third Party (CTP) motor accident claim. This article explains how to claim for assistance with daily activities, what evidence is needed, and how insurers assess care requirements under the Motor Accident Injuries Act 2017.
What types of care and family support are claimable under NSW CTP laws?
Under NSW CTP rules, injured people can claim compensation for care and family support costs that arise from a motor accident. This includes expenses for assistance with daily living tasks such as personal hygiene, meal preparation, and mobility support. It also covers costs for family members who reduce their work hours or stop working to provide care.
The New South Wales Motor Accident Injuries Act 2017 allows for claims covering:
- Home help services (e.g., assistance with dressing, bathing)
- Transportation to medical appointments
- Respite care for carers
- Costs of adaptive equipment (e.g., mobility aids)
- Support for managing household tasks
These claims are distinct from general damages for pain and suffering. They are statutory benefits under the CTP scheme, not common law claims. This means they are governed by specific rules about what is payable and how it is calculated.
How do CTP insurers assess care and family support needs?
Insurers evaluate care requirements by reviewing medical evidence and daily activity limitations. Key factors include:
- Medical reports confirming the injury's impact on daily living
- Evidence of reduced capacity to perform routine tasks (e.g., cooking, shopping)
- Documentation of family members' time spent providing care
- Statements from healthcare professionals about the need for support
For example, if an injured person requires assistance with dressing or mobility, a doctor's report detailing these limitations is essential. Insurers may also request evidence of how the injury affects the person's ability to manage household responsibilities.
What documentation is required to support a care and family support claim?
To claim care and family support benefits, you must provide:
- Detailed medical records from doctors, physiotherapists, or occupational therapists
- Invoices or receipts for care services (e.g., home help, transportation)
- Evidence of family members' lost income or reduced hours (e.g., payslips, employer statements)
- A care plan from a healthcare professional outlining specific support needs
- Statements from family members confirming their role in providing care
For instance, if a child requires assistance with personal care, a doctor's note confirming the need for support and a record of the care provider's services would be necessary. All documentation should clearly link the care needs to the motor accident.
Time limits, disputes and when to seek advice
CTP claims must be made within 52 weeks of the accident for certain benefits. If the injury is a 'threshold injury' (as defined in the Motor Accident Guidelines), weekly benefits and treatment payments may stop after 52 weeks. However, care and family support claims can continue beyond this period if the injury is severe enough to require ongoing assistance.
If an insurer disputes a claim, you may need to:
- Request a review of the decision
- Seek independent medical opinions
- Consult a legal professional to explore dispute resolution options
It's important to act promptly. Delays in submitting evidence or disputes over claim validity can affect the outcome. If your claim involves complex care needs or disputes, legal advice is recommended to ensure your rights are protected.
Next steps for injured road users
Understanding your care and family support entitlements is essential for managing recovery after a motor accident. Each claim is assessed based on its own facts, including the nature of the injury, the level of care required, and the impact on daily activities. To discuss your specific situation, complete the quick, no obligation enquiry form. Every claim depends on its own facts.