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).
NSW CTP insurers assess care and family support claims based on the Motor Accident Injuries Act 2017 and SIRA guidelines. This article explains the factors insurers consider, how they determine compensation, and steps to challenge decisions. Understanding these criteria helps claimants prepare evidence and navigate the claims process.
Legal Framework for Care and Family Support Claims
NSW CTP insurers must assess care and family support claims under the Motor Accident Injuries Act 2017. Section 4.4 of the Act limits benefits for injuries that do not meet the threshold injury criteria. SIRA guidelines clarify that care and family support claims must demonstrate a direct link between the injury and the need for unpaid care or support.
Insurers evaluate claims by considering:
- The nature and severity of the injury
- Medical evidence confirming care requirements
- The relationship between the injured person and the family member providing support
- The impact of the injury on the injured person's ability to perform daily tasks
Evidence That Matters for Care and Family Support Claims
Claimants must provide documented evidence to support their care and family support claims. Key evidence includes:
- Medical records confirming the injury and care needs
- Statements from healthcare professionals about the necessity of support
- Evidence of the family member's unpaid care role (e.g., witness statements, care logs)
- Financial records showing the impact of the injury on the family
Insurers often request detailed medical reports and may consult with SIRA's medical experts to assess the validity of claims. For example, if a car accident results in a spinal nerve-root injury requiring long-term care, the insurer will evaluate whether the injury meets the threshold injury criteria under the Motor Accident Guidelines.
Time Limits and Dispute Options
Claimants must notify their insurer within 52 weeks of the accident if they are seeking treatment and care benefits. However, family support claims are not subject to the same time limit. If an insurer rejects a claim, claimants can:
- Request a review of the decision
- Lodge a complaint with the NSW Civil and Administrative Tribunal (NCAT)
- Seek independent legal advice to challenge the insurer's assessment
Claimants should act quickly to gather evidence and address any insurer concerns. For instance, if an insurer disputes the need for family support, providing additional medical evidence or a care plan from a social worker may strengthen the claim.
When to Seek Legal Advice
Insurers may deny claims based on subjective interpretations of the injury's impact. If a claimant disagrees with an insurer's decision, they should seek legal advice to:
- Understand their rights under the Motor Accident Injuries Act 2017
- Challenge the insurer's assessment of care needs
- Explore options for dispute resolution
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.
Practical Example
Consider a scenario where a car accident results in a soft-tissue injury requiring a family member to provide unpaid care. The insurer may question whether the injury meets the threshold injury criteria. Claimants must provide medical evidence showing neurological signs, such as reduced reflexes or muscle weakness, to support their claim.
Next Steps
If you're seeking care and family support compensation after a motor accident, gather medical evidence and understand how insurers assess claims. Time limits and procedural requirements may affect your options. Complete the quick, no obligation enquiry form to request contact about your circumstances.