Eligibility for Care and Family Support in the NSW CTP Scheme
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).
If you have sustained a serious injury in a motor accident in Greater Sydney, you may be eligible for care and family support benefits under the NSW Compulsory Third Party (CTP) insurance scheme. These benefits are designed to assist individuals who require ongoing care due to injury, or whose family members are providing unpaid care that would otherwise be paid for. The scheme is governed by the Motor Accident Injuries Act 2017 and administered by the State Insurance Regulatory Authority (SIRA). Eligibility depends on the nature and severity of your injury, the level of care required, and whether the injury meets the legal threshold for compensation. This includes injuries that result in a permanent impairment or a significant and permanent loss of function.
What Care and Family Support Benefits Are Available
Under the NSW CTP scheme, you may be entitled to two forms of support related to care: treatment and care benefits, and family support payments. Treatment and care benefits cover the cost of professional care services, including nursing, physiotherapy, and personal care, provided by qualified professionals. Family support payments are available when a family member provides unpaid care that would otherwise be paid for by a professional. These payments are made directly to the unpaid carer and are intended to compensate for time, effort, and financial loss associated with providing care. The amount is determined by the hours of care provided and the carer’s level of responsibility, as assessed under the Motor Accident Guidelines.
Requirements for Eligibility
To qualify for care and family support benefits, you must meet several legal criteria. First, your injury must be a result of a motor accident that occurred on or after 1 December 2017, as the current CTP scheme under the Motor Accident Injuries Act 2017 applies to accidents from that date. Second, the injury must be assessed as a threshold injury, which includes a permanent impairment of at least 10% whole person impairment (WPI), or a permanent loss of function that significantly affects your ability to perform daily activities. For family support, the unpaid carer must provide care for a minimum of 10 hours per week, and the care must be necessary due to your injury. The need for care must be documented by a medical practitioner and supported by a care plan.
Evidence and Documentation That Matters
To support your claim, you will need to provide evidence that demonstrates the need for care and the nature of the unpaid care provided. This includes medical reports from your treating practitioner detailing your injury, functional limitations, and care needs. A formal care plan, prepared by a qualified health professional, is required to outline the type, frequency, and duration of care. For family support, you must provide a written statement from the carer describing the hours spent on care, the tasks performed, and the impact on their daily life. Supporting documents may include diary entries, photographs of care activities, and records of family meetings or care coordination. It is essential to preserve all correspondence with insurers, medical providers, and care coordinators.
Time Limits and Procedural Steps
There are time limits that apply to making a claim for care and family support under the CTP scheme. You must notify the insurer of your claim within 6 months of the accident, or within 6 months of becoming aware of a condition that may be attributable to the accident. Failure to meet this deadline may result in the claim being denied. After notifying the insurer, you must submit a formal claim application, which includes completing the SIRA claim form and attaching all required documentation. The insurer has 28 days to acknowledge the claim and 90 days to make a decision. If the claim is denied or delayed, you may request a review from the insurer or apply to the NSW Civil and Administrative Tribunal (NCAT) for a determination.
When to Seek Independent Advice
While the CTP scheme provides a structured pathway for care and family support, the process can be complex, particularly when assessing the level of care, the value of unpaid care, or when a claim is disputed. It is advisable to seek independent legal advice if you believe your claim has been undervalued, denied, or if you are unsure about the documentation required. An experienced legal adviser can help you understand your rights, prepare a strong claim, and represent you in any review or tribunal process. The decision to seek advice should be based on the severity of your injury, the complexity of your care needs, and the insurer’s response to your claim.
Hypothetical Example: A Case in Greater Sydney
A 42-year-old resident of North Ryde sustained a spinal injury in a motor accident on 15 March 2025. As a result, they require daily assistance with mobility, bathing, and meal preparation. Their spouse, who works part-time, provides 15 hours of unpaid care per week. A medical practitioner confirms a 15% WPI and recommends ongoing care. The spouse submits a care log and a statement detailing the hours and tasks performed. The claim for family support is assessed under the Motor Accident Guidelines and approved based on the documented need and hours provided.
Next Steps
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.