Care and Family Support Claims Under NSW CTP Scheme
Where a person's only injuries resulting from the accident are threshold injuries, weekly benefits and treatment and care generally cease after 52 weeks (ss 3.11 and 3.28).
If you're caring for a loved one injured in a motor accident in Balmain, you may be eligible for compensation through the NSW Compulsory Third Party (CTP) scheme. This article explains how the scheme covers care and family support claims, what evidence is needed, and how eligibility is determined.
What Types of Care Claims Are Covered?
The NSW CTP scheme allows family members or carers to claim compensation for care and support needs arising from a motor accident. This includes:
- Paid or unpaid care for a person with a threshold injury (e.g., soft tissue injuries meeting specific medical criteria)
- Support for daily living activities like bathing, dressing, or mobility assistance
- Financial compensation for lost income if you had to stop working to provide care
To qualify, the injured person must have a threshold injury, which is defined as an injury that meets the spinal nerve-root criteria in the Motor Accident Guidelines. This typically includes injuries like whiplash, muscle strains, or minor fractures.
Who Can Claim Care and Family Support?
You may be eligible if you are:
- A family member (spouse, child, parent, or sibling) of the injured person
- A carer who provides regular assistance to the injured person
- A dependent of the injured person (e.g., a child or elderly relative)
The injured person must be a driver, passenger, pedestrian, cyclist, or motorcyclist involved in a motor accident. Claims from carers of people injured in non-motor vehicle incidents are not covered.
How to Prove Eligibility
To claim care and family support, you'll need to provide:
- Medical evidence confirming the injured person's threshold injury
- Proof of your role as a carer (e.g., care records, witness statements, or employment records)
- Evidence of the care needs (e.g., a care plan or medical reports detailing daily assistance required)
- Income details if you're claiming lost earnings
SIRA (State Insurance Regulatory Authority) will assess whether the care needs are directly related to the injury and meet the scheme's criteria.
Time Limits and Dispute Resolution
You must submit a claim within 52 weeks of the accident if the only injuries are threshold injuries. If the injured person has a whole person impairment (WPI) of 10% or more, you may be eligible for ongoing benefits. Claims involving long-term care needs should be submitted before the 52-week period to avoid losing benefits.
If your claim is denied, you can request a review through SIRA's internal process. In some cases, legal advice may be necessary to challenge a decision or negotiate a fair outcome.
Example Scenario
A mother in Balmain is caring for her son after he was injured in a car accident. The son has a threshold injury requiring assistance with daily activities. The mother submits a claim for care support, providing medical records confirming the injury and evidence of her caregiving role. SIRA approves the claim, covering the cost of home care services.
When to Seek Legal Advice
Consult a lawyer if:
- Your claim is denied and you're unsure how to appeal
- You need help gathering evidence
- You're unsure if your care needs meet the scheme's criteria
- You want to understand how to dispute a decision
Legal professionals can help ensure your claim is processed correctly and that you receive the support you're entitled to under the NSW CTP scheme.
Next Steps
Care and family support claims under the NSW CTP scheme depend on the injury's severity, the claimant's relationship to the injured person, and the evidence provided. If you're in Balmain and need assistance with a claim, time limits, or dispute resolution, complete the quick, no obligation enquiry form to request contact about your circumstances.