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).
In New South Wales, the State Insurance Regulatory Authority (SIRA) funds treatment costs for care and family support under Compulsory Third Party (CTP) motor accident claims. This article explains how SIRA covers medical treatment, therapy, and home care expenses, and outlines what evidence is needed to claim funding in Ballina. It also covers time limits and when to seek legal advice.
How SIRA Funds Care and Family Support Costs
SIRA’s Motor Accident Injuries Act 2017 governs funding for treatment costs related to care and family support. Under this scheme, claimants may receive:
- Medical treatment costs (e.g., physiotherapy, occupational therapy, and specialist consultations)
- Home care services (e.g., nursing care, cleaning, and meal preparation)
- Family support payments for unpaid carers (e.g., a spouse or relative providing daily assistance)
Funding is limited to directly related treatment costs. For example, if a carer provides 20 hours of support per week, SIRA may cover the cost of hiring a professional carer for those hours. However, non-medical support like emotional or domestic help is generally not funded.
Evidence Required for Funding Claims
To claim funding for care and family support, you must provide:
- Medical records confirming the injury and care needs (e.g., a doctor’s report stating the need for home care)
- Care plans from healthcare professionals detailing the type and frequency of support required
- Invoices or receipts for treatment costs (e.g., therapy sessions, medical equipment, or home care services)
- Documentation of family support (e.g., a letter from a family member confirming their role as a carer)
For example, if a claimant requires 10 hours of nursing care per week, they must provide a care plan from a nurse and invoices for those hours. SIRA will assess whether the care is medically necessary and within the funded scope.
Time Limits and Dispute Options
CTP claims must be submitted within 52 weeks of the accident date for most benefits. After this period, weekly income payments and treatment benefits are generally limited unless the claimant has a threshold injury (a defined level of harm under the Motor Accident Guidelines). If a claimant’s only injuries are threshold injuries, SIRA may stop funding after 52 weeks.
If an insurer denies a claim or disputes the amount, claimants can:
- Request a review by SIRA
- Seek independent medical opinions to challenge the decision
- Consult a specialist solicitor for disputes over funding eligibility
When to Seek Legal Advice
Claimants should seek legal advice if:
- They are unsure whether their care needs qualify for funding
- Their claim is denied or delayed
- They face disputes over the amount of funding
Legal professionals can help navigate SIRA’s rules, ensure all evidence is submitted correctly, and challenge decisions that may unfairly limit funding.
Next Steps
CTP funding for care and family support depends on the accident date, injury type, and evidence provided. To request contact about your circumstances, complete the quick, no obligation enquiry form.