Understanding Care and Family Support in NSW CTP Claims
If you or a family member have suffered a serious injury in a motor accident in NSW, you may be entitled to compensation for care and family support needs. This support is intended to cover both paid care and the value of unpaid assistance provided by family members. In Bathurst, as across NSW, disputes may arise when the insurer or the Motor Accident Injuries Scheme (SIRA) denies or limits these entitlements. The resolution of such disputes follows a structured process under the Motor Accident Injuries Act 2017 and the Motor Accident Injuries Regulation 2017.
How SIRA Handles Disputes Over Care and Family Support
SIRA is the statutory body responsible for administering the CTP scheme in NSW. When a dispute arises over care and family support, SIRA provides a formal process to resolve it. The process begins with a written request for review from the claimant or their representative. SIRA will assess the claim based on medical evidence, care plans, and the nature of the injury. If the initial review does not resolve the issue, the claimant may request a review by the Personal Injury Commission (PIC), which is an independent body that can hear disputes on medical and financial matters.
SIRA does not determine entitlements based on location alone. A claimant in Bathurst is subject to the same legal standards as someone in Sydney or Newcastle. The focus is on the severity of the injury, the need for ongoing care, and the actual provision of support by family members. SIRA may require a report from an independent medical practitioner to assess the claimant’s capacity for self-care and the level of assistance required.
Key Steps for Claimants in Bathurst
To address a dispute over care and family support, claimants should take the following steps:
- Obtain a formal care plan from a qualified medical practitioner or allied health professional, detailing the type, frequency, and duration of care required.
- Document all unpaid care provided by family members, including the number of hours per week, the nature of tasks (e.g. bathing, medication management, transport), and the identity of the caregiver.
- Submit a written request for review to the insurer or SIRA within 60 days of receiving a decision that denies or limits entitlements.
- If the review is unsuccessful, apply to the Personal Injury Commission for a determination on the dispute.
These steps are critical. Delays or incomplete evidence may result in a decision that does not reflect the actual care needs.
Evidence That Matters in Care and Family Support Disputes
The strength of a claim depends on the quality and consistency of evidence. SIRA will assess:
- Medical reports confirming the long-term or permanent nature of the injury and the need for assistance with daily activities.
- A care plan developed by a registered nurse, physiotherapist, or occupational therapist.
- A diary or log maintained by the family member providing unpaid care, recording the time spent and tasks performed.
- Statements from witnesses, including other family members or healthcare providers, confirming the level of support.
- Records of any paid care arrangements, including invoices and service provider details.
SIRA may also consider the claimant’s pre-accident functional capacity and whether the injury has resulted in a permanent loss of ability to perform basic self-care tasks.
Time Limits and the Dispute Resolution Pathway
Time limits apply. A request for review must be made within 60 days of receiving a decision. Failure to meet this deadline may prevent further review. If the claimant seeks a determination from the Personal Injury Commission, the application must be made within 12 months of the original decision.
The PIC process allows for a medical dispute to be heard independently. If a medical assessment is disputed, the PIC may order a new assessment by a specialist medical practitioner. The claimant has the right to present evidence and make submissions. However, a challenge does not guarantee a change in outcome. The PIC’s decision is binding on the insurer and SIRA.
A Realistic Example: Family Support in a Regional Claim
A 58-year-old man in Bathurst sustained a spinal injury in a motor accident in February 2025. He requires daily assistance with mobility, toileting, and meal preparation. His daughter, who lives with him, provides this care for 40 hours per week. The insurer initially denied family support payments, arguing that the daughter’s assistance was not 'substantial' and that the claimant could manage with minimal help.
The claimant submitted a care plan from his physiotherapist, a log from his daughter detailing the hours and tasks, and a medical report confirming his permanent inability to perform basic self-care tasks. After a review by SIRA, the claim was upheld. The daughter’s unpaid care was recognised as a valid and necessary support, and a family support payment was awarded.
When to Seek Independent Advice
Disputes over care and family support can be complex. The legal and medical standards are strict, and the burden of proof lies with the claimant. If you are in Bathurst and have been denied or limited in your entitlement to care and family support, it is advisable to seek independent advice before proceeding with a formal review or application to the Personal Injury Commission.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.