Care and Family Support in NSW CTP Claims
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're injured in a motor vehicle accident in Albury and need help with care or family support, the NSW Compulsory Third Party (CTP) scheme may cover your costs. This article explains how the scheme handles care and family support claims, what evidence you need, and when to seek legal advice.
What Types of Care and Family Support Are Covered?
Under the NSW CTP scheme, you may claim for care and family support if your injury requires assistance with daily living tasks. This includes:
- Paid care services like home help or nursing
- Unpaid family care if a relative or friend provides support
- Support for dependent children or elderly family members
The New South Wales Motor Accident Injuries Act 2017 (s 4.4) limits benefits to injuries meeting the 'threshold injury' definition. SIRA assesses whether your injury qualifies for care support based on medical evidence.
How SIRA Assesses Eligibility
SIRA uses the Motor Accident Guidelines to determine if your injury meets the threshold for care support. Key factors include:
- Medical reports confirming your injury's severity
- Evidence of care needs (e.g., difficulty with personal hygiene, mobility, or continence)
- Documentation of your family's ability to provide support
For example, if you have a spinal nerve-root injury with neurological signs, SIRA may consider this a threshold injury requiring care support.
Documentation Needed for Family Care Claims
To support your claim, you'll need:
- Medical records showing your injury's impact on daily living
- Evidence of your care needs (e.g., doctor's notes, care plans)
- Proof of your family's involvement (e.g., witness statements, care diaries)
- Financial records if you're claiming paid care services
Keep all documents organized and submit them to your CTP insurer promptly.
Disputes Over Care Costs
If your insurer disputes your claim, you may need to:
- Request a review of your claim with the insurer
- Seek mediation through the NSW Civil and Administrative Tribunal (NCAT)
- Lodge a formal dispute with SIRA
Disputes often hinge on whether your injury meets the threshold injury definition. Always keep detailed records of all correspondence.
Time Limits for Claims
You have 52 weeks from the accident date to claim care support benefits under the CTP scheme. After this period, weekly benefits typically stop unless your injury is classified as a 'threshold injury' under s 3.28.
When to Seek Legal Advice
Consult a solicitor if:
- Your insurer refuses your claim without explanation
- You need help navigating SIRA's assessment process
- You're unsure if your injury qualifies for support
A lawyer can help you understand your options and ensure your claim meets all legal requirements.
Next Steps
CTP claims depend on the accident date, injury type, and evidence collected. To discuss your circumstances, complete the quick, no obligation enquiry form. Every claim depends on its own facts.