What Types of Care and Family Support Are Covered Under NSW CTP?
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).
Under the Motor Accident Injuries Act 2017, people injured in a motor accident in New South Wales may be entitled to compensation for care and family support needs. This includes both paid care and unpaid assistance provided by family members. Paid care covers professional support such as nursing, personal care, or home help services arranged to manage daily tasks like bathing, dressing, or meal preparation. Unpaid care refers to support provided by a family member or close friend, such as a spouse, parent, or sibling, who spends time assisting with personal care, household duties, or medical appointments.
The law recognises that serious injuries, such as spinal cord injuries, traumatic brain injuries, or major orthopaedic trauma, can significantly reduce a person’s ability to perform everyday activities. In these cases, a claim for care and family support may be made to cover the cost of professional care or to compensate for the time a family member spends providing assistance.
How Insurers Assess Care and Family Support Claims in the Newcastle and Hunter Region
Insurers assess care and family support claims based on the Motor Accident Injuries Regulation 2017 and the Motor Accident Guidelines. The assessment focuses on whether the injury has resulted in a need for care that would not have existed but for the accident. The claim must demonstrate that the injured person requires assistance with at least two of the following: personal care, mobility, household tasks, or managing medical treatment.
In the Newcastle and Hunter region, claims are assessed using the same national standards applied across NSW. Insurers review medical reports, care plans, and evidence of time spent by family members. For unpaid care, the claimant must provide a detailed log of hours spent assisting, along with a statement from the caregiver explaining the nature and duration of the support.
SIRA (the State Insurance Regulatory Authority) provides guidance to insurers and claimants on what constitutes a reasonable and necessary care need. The assessment considers the severity and permanence of the injury, the availability of alternative support, and whether the care is directly related to the accident.
Practical Examples of Care and Family Support Claims in the Newcastle and Hunter Region
A 42-year-old man from Maitland was involved in a head-on collision on the Pacific Highway in 2024. He sustained a spinal cord injury at T10, resulting in partial paralysis and loss of mobility. He required assistance with all personal care tasks and could not independently prepare meals or manage household chores.
He received 12 hours per week of paid home care through his CTP claim. His wife, who worked part-time, also provided 20 hours per week of unpaid care. After submitting medical reports, a care plan from a rehabilitation specialist, and a diary of her assistance, the insurer approved a payment for her unpaid care based on the national hourly rate for informal care under the Motor Accident Guidelines.
Another example involved a 16-year-old student from Lake Macquarie who sustained a traumatic brain injury in a collision on the Waratah Road. She required supervision for basic tasks, including eating, medication management, and attending school. Her mother reduced her work hours to 10 per week to provide care. The claim was supported by a neuropsychologist’s report and a time log showing 15 hours per week of unpaid care. The insurer accepted the claim and awarded compensation for the time lost and for the cost of paid care.
These cases reflect how SIRA’s framework is applied in practice across the Hunter region. The focus remains on the actual need for care, the nature of the injury, and the verifiable contribution of the caregiver.
What Evidence Matters for a Care and Family Support Claim
To support a claim for care and family support, the following evidence is typically required:
- A medical report from a treating practitioner confirming the injury and its impact on daily functioning.
- A formal care plan developed by a rehabilitation professional, outlining the type, frequency, and duration of care needed.
- For paid care: invoices or receipts from registered care providers.
- For unpaid care: a signed statement from the caregiver detailing the tasks performed and the number of hours spent per week, supported by a diary or log.
- A record of any changes in the claimant’s ability to perform daily tasks since the accident.
Photographs of the accident scene, witness statements, and police reports may also be useful to confirm the circumstances of the injury, particularly if there is a dispute about the nature or timing of the accident.
Time Limits and Procedural Requirements
A claim for care and family support must be made within the time limits set by the Motor Accident Injuries Act 2017. The claim must be notified to the insurer within 6 months of the accident, or within 6 months of when the claimant first became aware of the injury, whichever is later. Failure to meet this deadline may result in the claim being barred.
If the insurer refuses to pay for care or family support, the claimant may request a review under SIRA’s dispute resolution process. If unresolved, the matter may be referred to the NSW Civil and Administrative Tribunal (NCAT) for determination.
When to Seek Independent Advice
Care and family support claims can be complex, particularly when the injury is serious or the claim involves unpaid care by a spouse or parent. The value of the claim depends on the duration of care, the hourly rate used, and whether the injury is considered a threshold injury under the Act.
Given the regional variation in access to care services and the need for accurate documentation, it is advisable to seek independent advice before finalising a claim. This is especially important in areas such as the Hunter, where access to specialist rehabilitation services may vary between suburbs.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.