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 or a family member need care or support after a serious road injury, understanding your eligibility for NSW CTP scheme benefits is essential. The Care and Family Support provisions under the Motor Accident Injuries Act 2017 (MAIA) provide financial assistance for unpaid care needs and essential support services. This article explains who qualifies, what care is covered, how to prove your claim, and time limits for making a care and family support claim under the NSW CTP scheme.
Who is eligible for care and family support claims?
Under the NSW CTP scheme, care and family support benefits are available to injured road users and their dependants. To qualify, the injured person must have suffered a threshold injury or higher, as defined in the Motor Accident Guidelines. This includes injuries such as whiplash, soft tissue damage, or spinal nerve-root injuries meeting specific clinical criteria.
Eligibility also extends to family members or unpaid carers who provide essential care due to the injury. For example, if a child or dependent requires assistance with daily living tasks, a parent or guardian may be eligible for financial support to cover care costs. The injured person must be a driver, passenger, pedestrian, cyclist, or motorcyclist involved in a motor vehicle accident covered by the CTP scheme.
What types of care and support are covered?
The CTP scheme covers two main categories of care and family support:
- Unpaid care needs: This includes assistance with daily living tasks such as eating, dressing, or personal hygiene. It also covers support for managing household responsibilities like cooking or cleaning.
- Paid care needs: This covers essential support services such as home help, respite care, or assistance with mobility equipment. It may also include support for medical appointments or transportation to healthcare facilities.
The scheme does not cover routine household tasks or general childcare unless they are directly related to the injured person’s care needs. For example, a parent caring for a child with a serious injury may be eligible for support, but routine childcare for a healthy child is not covered.
How to prove eligibility for care and family support claims?
To claim care and family support benefits, you must provide evidence of:
- A medical report confirming the injured person’s threshold injury or higher.
- A care plan or evidence of unpaid care needs, such as a letter from a carer or a care provider.
- Proof of the injured person’s involvement in a motor vehicle accident covered by the CTP scheme.
- Documentation of care costs, such as invoices for paid support services or records of unpaid care hours.
Medical records are critical. For example, if the injured person requires assistance with mobility, a doctor’s report confirming this need must specify how it impacts their daily life. SIRA (State Insurance Regulatory Authority) will assess whether the care needs meet the scheme’s criteria.
Time limits for making a care and family support claim
Claims for care and family support must be made within 52 weeks of the accident date. If the injured person’s only injuries are threshold injuries, benefits for care and family support will generally stop after 52 weeks. However, if the injury results in a whole person impairment of 10% or more, the 52-week limit does not apply to care needs.
If you are unsure whether your claim falls within the time limit, contact SIRA directly. Delays in submitting evidence can result in benefits being denied.
When to seek legal advice
While the CTP scheme provides a clear framework for care and family support claims, disputes can arise over eligibility, evidence requirements, or time limits. For example, if a carer’s needs are disputed or if the injured person’s injury does not meet the threshold criteria, SIRA may require further medical assessment.
If you are unsure whether your circumstances fall within the scheme’s coverage, it is important to seek legal advice. A solicitor can help you understand your options and ensure your claim is submitted correctly.
Example: A family’s care needs after a serious injury
Consider a scenario where a parent is involved in a motor accident and suffers a spinal nerve-root injury requiring ongoing care. Their child, who is a full-time carer, may be eligible for financial support to cover unpaid care hours. A medical report confirming the injury’s severity and a care plan detailing the child’s responsibilities would be essential to support the claim.
Next steps
Understanding your eligibility for care and family support under the NSW CTP scheme depends on the accident date, injury type, and evidence provided. If you are unsure whether your circumstances qualify, or if you need help preparing a claim, complete the quick, no obligation enquiry form to request contact about your circumstances.
Every claim depends on its own facts. Time limits and procedural requirements may apply. To request contact about your circumstances, complete the quick, no obligation enquiry form.