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).
In New South Wales, the Compulsory Third Party (CTP) scheme covers care and family support costs for injured road users. This includes funding for medical treatment, home care, and assistance with daily living after a motor accident. If you're in Ballina and seeking compensation for these expenses, understanding the legal framework and required evidence is essential. This article explains how NSW CTP claims cover care-related costs, outlines SIRA’s eligibility criteria, and details the documentation needed to claim support funding.
What CTP Claims Cover for Care and Family Support
Under the Motor Accident Injuries Act 2017, CTP insurers must cover treatment-related care and family support costs. This includes:
- Paid care (e.g., nursing, physiotherapy, or occupational therapy)
- Unpaid family support (e.g., a carer’s time spent assisting with daily tasks)
- Home modifications (e.g., ramps or grab rails)
- Transportation costs for medical appointments
SIRA’s guidelines clarify that funding is available for care and support needed due to injuries caused by a motor vehicle accident. However, the scope is limited to costs directly related to treatment and recovery. For example, if an injured person requires assistance with bathing or meal preparation, the CTP insurer must cover the cost of a carer’s time or wages.
How SIRA Determines Eligibility
SIRA assesses claims based on medical evidence and the nature of the injury. To qualify for care and family support funding:
- Medical documentation must confirm the need for care (e.g., a doctor’s report stating mobility limitations)
- Care plans must be provided by a registered medical practitioner
- Cost records must show the expenses incurred (e.g., invoices for home care services)
SIRA’s What You Can Claim page states that funding is available for “care and assistance required due to the injury.” This includes both professional care and unpaid family support. However, the insurer may require a detailed breakdown of how the care directly relates to the injury.
Documentation Required for Claims
To claim care and family support funding, you’ll need to provide:
- Medical records showing the injury’s impact on daily living
- Care provider invoices or receipts
- Witness statements (if applicable)
- Proof of income for unpaid family support (e.g., a carer’s payslip)
- Accident reports from the NSW Police or relevant authorities
For example, if a cyclist in Ballina requires a carer to assist with mobility after a collision, the claimant must provide evidence of the care’s necessity and cost. SIRA may also request a medical opinion confirming the care’s direct link to the injury.
Time Limits and Dispute Resolution
CTP claims must be submitted within 52 weeks of the accident, unless an extension is granted. If a claimant misses this deadline, they may lose entitlement to certain benefits. However, exceptions apply if the injury’s effects were not immediately apparent.
Disputes over funding can be resolved through SIRA’s mediation process. If the insurer refuses a claim, the claimant may need to seek legal advice to challenge the decision. It’s important to act promptly, as delays can affect the availability of funding for essential care.
When to Seek Legal Advice
While SIRA provides a clear framework for care and family support claims, navigating the process can be complex. A solicitor can help:
- Verify whether your care needs meet SIRA’s criteria
- Prepare and submit required documentation
- Challenge a rejected claim
If you’re in Ballina and unsure whether your care costs are covered, contact LegalAdvice.com.au for a free, no-obligation assessment. Every claim depends on its own facts, and the right support can make a significant difference in recovery.