Understanding Family Care Support in NSW CTP Claims
If you or a family member sustained a serious injury in a motor accident in Greater Sydney, you may be entitled to compensation for unpaid care provided by family members. This support is known as family care or care and family support benefits under the Motor Accident Injuries Act 2017 (NSW). These benefits are not automatic and require clear evidence that a family member has provided care that would otherwise have been paid for by a professional carer.
The assessment of care needs is governed by the Motor Accident Injuries Act 2017 and the Motor Accident Injuries Regulation 2017. The insurer or the State Insurance Regulatory Authority (SIRA) will assess whether the care was necessary, reasonable, and directly related to the injury. This means that not all family support will qualify, only care that is clinically justified and not merely routine assistance.
What Documentation Supports a Family Care Claim?
To establish entitlement to family care benefits, you must provide a structured and comprehensive record of the care provided. The following documents are typically required:
- A detailed written statement from the person providing care, including the nature, frequency, duration, and purpose of each care activity.
- Medical reports from treating practitioners confirming the injury, the need for ongoing care, and the impact on daily functioning.
- A care log or diary maintained by the carer, recording daily or weekly care tasks (e.g., bathing, dressing, preparing meals, managing medications, accompanying to appointments).
- Evidence of the carer’s time commitment, such as a timesheet or a record of hours worked per week.
- Proof that the care would have been provided by a paid carer if not for the family arrangement (e.g., quotes from home care providers, or evidence that the carer was previously employed in a care role).
- If the carer is employed, evidence of any income loss, including payslips, employer letters, or tax returns showing reduced hours or unpaid leave.
SIRA considers that care must be necessary due to the injury and not simply a result of personal preference or family convenience. For example, a parent caring for a child with a spinal injury who cannot walk independently may qualify, but a sibling helping with household chores after a minor soft-tissue injury may not.
How to Organise Your Evidence
Begin documenting care from the earliest possible point after the accident. Delayed or incomplete records reduce the likelihood of approval. Use a simple, consistent format:
- Start a daily or weekly care log, noting the date, time, duration, and description of each care activity.
- Attach copies of medical reports, including assessments of functional impairment and recommendations for care.
- Submit a formal statement from the carer, signed and dated, outlining their role and the impact on their time and capacity.
- Include any correspondence with the insurer, including claim forms, letters, and email exchanges.
- If applicable, provide evidence of income loss, such as a letter from the employer confirming reduced hours, or a tax return showing lower earnings.
For Greater Sydney residents, it is helpful to note that SIRA uses a standard assessment framework across the state. While local differences in healthcare access or family structure may exist, the legal criteria for family care benefits are uniform. The key is consistency, accuracy, and direct linkage between the injury and the care provided.
What SIRA Considers When Assessing Family Care Claims
SIRA evaluates family care claims based on three core criteria under the Motor Accident Injuries Act 2017:
- The care must be necessary because of the injury.
- The care must be reasonable and appropriate to the nature and severity of the injury.
- The care must not be provided in a way that would normally be expected of a family member in the absence of injury (e.g., basic household help).
SIRA may also assess whether the carer is a close family member (including spouse, child, parent, sibling, or de facto partner) and whether the care was provided without payment. A carer who previously worked in aged care and now provides care for a sibling with a traumatic brain injury may have a stronger case than someone who previously had no care experience.
A hypothetical example: A 45-year-old mother in North Sydney sustained a spinal injury in a car crash. She now requires assistance with all personal care tasks and cannot leave her home without help. Her adult daughter, who previously worked as a nurse, has taken time off work to provide care. The daughter submits a weekly log of 30 hours of care, medical reports confirming the need for supervision and assistance, and a letter from her former employer confirming her nursing qualifications. SIRA would assess whether the care was necessary, reasonable, and not routinely expected.
Time Limits and Procedural Requirements
You must notify the insurer of your intention to claim family care benefits within 12 months of the accident. This deadline is strict and not extended by administrative delays. Failure to notify within this period may result in the claim being barred.
If the insurer refuses to pay or disputes the amount, you may request a review under the Motor Accident Injuries Act 2017. You can also apply to SIRA for a determination if the dispute remains unresolved. It is advisable to seek independent legal advice before initiating a review or formal application.
When to Seek Independent Advice
Family care claims often involve complex assessments of need, reasonableness, and value. The burden of proof lies with the claimant. If you are unsure whether your care qualifies, or if the insurer has rejected your claim, it is prudent to consult a qualified legal practitioner experienced in CTP claims. They can help you gather and present evidence in a way that meets SIRA’s standards.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.