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).
Families supporting injured loved ones in NSW CTP claims must understand how to prepare for medical assessments. Under the Motor Accident Injuries Act 2017, care needs, including unpaid family support, are covered under the Compulsory Third Party (CTP) scheme. This article explains how to navigate medical evaluations, what evidence matters, and how to coordinate care while meeting SIRA’s requirements on the Central Coast.
Role of family support in CTP medical assessments
Family support is a critical component of care needs in CTP claims. When an injured person requires assistance with daily living tasks, such as personal hygiene, mobility, or household duties, this is classified as a 'care need' under the scheme. SIRA’s guidelines state that unpaid family or carer support is eligible for compensation if it is necessary due to the injury.
Medical assessments evaluate whether care needs are 'reasonable and necessary' under the injury’s severity. For example, if a car accident caused a spinal injury requiring 24-hour assistance, the family’s role in providing this support would be documented in medical records. SIRA’s What you can claim page confirms that care needs are assessed based on the injured person’s functional limitations and the care provider’s capacity to meet those needs.
Preparing for CTP-related medical evaluations
Families should take practical steps to ensure medical assessments reflect the care needs accurately. Key actions include:
- Documenting the care role: Keep records of how family members assist with tasks like dressing, meals, or mobility. Written notes from the injured person about their dependency on family support are valuable.
- Coordinating with healthcare providers: Ensure doctors or physiotherapists note the impact of the injury on daily living. For instance, a doctor might state that the injured person requires assistance with bathing due to limited mobility.
- Understanding assessment criteria: SIRA’s Making a motor accident claim guide explains that care needs must be 'reasonably necessary' and not excessive. Families should ask medical professionals to clarify how the injury affects the injured person’s ability to perform tasks independently.
A hypothetical example: After a motorbike accident, a 45-year-old mother requires help with cooking and personal care. Her family documents their role in these tasks and provides a letter from a physiotherapist confirming the need for assistance. This evidence supports the claim for care-related compensation.
Key considerations for families coordinating care
When preparing for medical assessments, families must balance the injured person’s needs with the practicalities of care. SIRA’s guidelines emphasize that care needs are assessed based on the injury’s impact, not the family’s availability. For instance, if the injured person requires assistance with toileting but can manage meals independently, the care need is limited to the toileting task.
Families should also be aware of time limits. Under the Motor Accident Injuries Act 2017, claims must be submitted within 52 weeks of the injury if the injured person’s only injuries are 'threshold injuries' (soft tissue injuries meeting specific medical criteria). However, if the injury involves a whole-person impairment (e.g., a brain injury), the 52-week limit does not apply. Families should consult SIRA’s What you can claim page to determine the applicable timeframe.
Disputes, time limits and when to seek advice
If a family feels their care needs are not being properly assessed, they may need to request a review. SIRA’s process allows for disputes to be resolved through its internal review mechanism or by applying to the NSW Civil and Administrative Tribunal (NCAT). Families should also be mindful of the 52-week deadline for claims involving only threshold injuries, as delays can affect eligibility for certain benefits.
In complex cases, families may benefit from seeking independent legal advice. While this article provides general guidance, individual circumstances, such as the nature of the injury, the availability of medical evidence, or the need for long-term care, can significantly affect the outcome. Families should ensure all documentation reflects the injured person’s needs and aligns with SIRA’s assessment criteria.
Next steps for families on the Central Coast
Preparing for medical assessments requires careful coordination between families, healthcare providers, and claimants. By documenting care needs, understanding SIRA’s guidelines, and acting within time limits, families can support their loved ones’ CTP claims effectively. For tailored advice on your specific situation, complete the quick, no obligation enquiry form to request contact about your circumstances.