Understanding 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 or a family member have sustained a serious injury in a motor accident in New South Wales, the Compulsory Third Party (CTP) insurance scheme may provide financial support for care and family assistance needs. This includes funding for treatment costs that arise from the injury, particularly when ongoing care is required. The CTP scheme covers both paid and unpaid care, such as help with daily living tasks, personal care, and support for family members who provide care without pay. This support is available under the Motor Accident Injuries Act 2017 and is administered by the State Insurance Regulatory Authority (SIRA).
What Types of Care and Family Support Costs Are Covered?
Under the NSW CTP scheme, eligible individuals may claim for care and family support costs that result from a motor accident injury. These include:
- Payment for professional care services, such as home care, personal care, or nursing support
- Reimbursement for out-of-pocket expenses incurred by family members who provide unpaid care, such as travel, loss of income, or equipment
- Compensation for the time a family member spends providing care, particularly when that time reduces their ability to work or earn income
The scheme does not cover all forms of support. For example, general household assistance or routine domestic tasks not directly related to the injury are not compensable. The focus is on care needs that arise because of the injury and that would not have existed otherwise.
How Treatment Costs Are Funded Through CTP
Treatment costs related to care and family support are funded through the CTP scheme under the category of treatment and care benefits. These benefits are available regardless of fault, provided the injury is not classified as a minor (or threshold) injury. If the injury is a threshold injury, the claim may still be eligible for treatment and care benefits, but only for a limited period and subject to specific conditions.
The CTP insurer must provide funding for treatment and care services that are reasonable, necessary, and directly related to the injury. This includes services such as:
- Home modifications to support mobility or safety
- Provision of assistive devices, such as wheelchairs or hoists
- Professional care services delivered in the home or community
Funding is not automatic. The claimant must provide evidence that the care is required, that it is being provided, and that it is reasonable and necessary. The insurer may assess and approve claims based on medical reports, care plans, and cost estimates.
What Documentation Is Required to Claim Care and Family Support?
To claim care and family support costs through CTP, you must provide clear and detailed documentation. The following items are typically required:
- A medical report from a treating practitioner confirming the need for care and its link to the accident
- A formal care plan outlining the type, frequency, and duration of care required
- Itemised invoices or receipts for paid care services
- Evidence of unpaid care, including a written statement from the carer detailing the time spent, tasks performed, and impact on their work or daily life
- Proof of income loss for unpaid carers, if claiming for time spent providing care
SIRA advises that claims for unpaid care must demonstrate that the care was provided because of the injury and that the carer would not have provided it otherwise. The claim must also show that the care was not available through other sources, such as government support programs.
How This Differs from Other CTP Claim Categories
Care and family support funding is distinct from other CTP claim categories. It is not the same as:
- Medical treatment benefits, which cover costs for diagnosis, therapy, and medical procedures
- Weekly income payments, which compensate for loss of earnings due to injury
- Damages, which are awarded in a common law claim for pain and suffering, future care needs, or permanent impairment
Treatment and care benefits under CTP are designed to cover the actual costs of care, not to replace income or compensate for non-economic loss. They are not subject to the same threshold injury rules as damages, but they are limited in duration and scope if the injury is classified as a threshold injury.
Practical Steps to Take After an Accident
If you or a family member have sustained a serious injury and require care, take the following steps:
- Seek medical treatment immediately and keep all records
- Document the need for care, including how it affects daily life
- Identify and record details of all care providers, both paid and unpaid
- Gather and preserve all invoices, receipts, and correspondence with insurers
- Notify the CTP insurer as soon as possible, ideally within 12 months of the accident
Delay in notifying the insurer may affect the claim. While there is no strict deadline for making a claim, it is best to act promptly to preserve evidence and ensure timely processing.
Hypothetical Example: Supporting a Family Member with a Spinal Injury
A 45-year-old woman was injured in a motor accident in Sydney. She sustained a spinal injury that required ongoing personal care, including help with bathing, dressing, and mobility. Her husband, who works full time, began providing care at home. He was unable to work full hours for two months while supporting her. The family submitted a claim for unpaid care, including travel costs, loss of income, and a formal care plan. The insurer approved funding for paid home care and reimbursed the husband for 40% of his lost income, based on medical evidence and a documented care schedule.
Time Limits and Dispute Options
There is no fixed time limit for making a CTP claim for care and family support, but claims must be made within 12 months of the accident to avoid complications. If a claim is denied or only partially approved, the claimant may request a review from the insurer or apply to the Civil and Administrative Tribunal (NCAT) for a decision. SIRA provides guidance on dispute resolution and encourages early communication with the insurer.
When to Seek Independent Advice
The CTP scheme is complex, particularly when care and family support are involved. Factors such as the nature of the injury, the type of care provided, and the availability of other support services can affect eligibility. It is advisable to seek independent legal or claims advice if:
- The insurer denies a claim or offers less than expected
- There is a dispute about the value of unpaid care or the reasonableness of costs
- The injury is serious or long-term, and future care needs are uncertain
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.