How SIRA defines care and family support in NSW CTP claims
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 Care and family support entitlement under the Compulsory Third Party (CTP) scheme is governed by the Motor Accident Injuries Act 2017 and SIRA guidelines. SIRA (State Insurance Regulatory Authority) outlines that care and family support refers to assistance required by an injured person due to their inability to perform daily tasks after a motor accident. This includes both paid and unpaid care, such as help with personal hygiene, meals, or mobility. SIRA’s rules clarify that such support must be directly related to the injury caused by the accident and not a general domestic duty.
Legal framework for care and family support claims
Under the Motor Accident Injuries Act 2017, care and family support is a statutory benefit available to injured persons who meet the threshold injury criteria. SIRA’s Motor Accident Claims Guide specifies that this entitlement applies when the injury results in a whole person impairment (WPI) of 10% or more. For example, if an accident causes a spinal nerve-root injury with neurological signs, SIRA may assess this as a threshold injury eligible for care support.
SIRA distinguishes care and family support from other domestic duties claims. While care support is tied to the injury’s impact on daily living, domestic duties claims (e.g., caring for a child or household tasks) are generally not covered under the CTP scheme. This distinction is critical: only injuries directly linked to the accident qualify.
Practical steps and evidence for care claims
To claim care and family support, you must provide evidence of:
- Medical documentation confirming the injury’s link to the accident (e.g., a doctor’s report stating the injury caused mobility issues)
- Proof of care needs (e.g., a care provider’s statement or a family member’s testimony)
- Financial records if seeking paid care (e.g., invoices from a carer)
- Accident details (e.g., police report, witness statements)
SIRA also requires a medical practitioner’s assessment to determine if the injury meets the threshold criteria. For instance, if a cyclist’s accident results in a soft tissue injury with radiculopathy (nerve-related symptoms), SIRA may classify this as a threshold injury eligible for care support.
Time limits and dispute resolution
Claims for care and family support must be made within 52 weeks of the accident, unless the injury is classified as a threshold injury. If the injury does not meet the threshold, benefits are generally limited to 52 weeks. However, if the injury is a threshold injury, SIRA may extend support beyond this period depending on the whole person impairment rating.
Disputes over care claims can be resolved through SIRA’s internal review process or by lodging a complaint with the NSW Civil and Administrative Tribunal (NCAT). It is essential to act promptly, as delays may affect eligibility.
When to seek legal advice
If your care needs exceed what SIRA deems reasonable, or if you believe the injury meets the threshold criteria, consulting a specialist solicitor is advisable. A lawyer can help challenge SIRA’s assessment or negotiate a fair outcome. For example, if a family member’s care is required for more than 52 weeks but SIRA denies the claim, legal assistance may be necessary to appeal the decision.
Example of a care claim
Consider a scenario where a pedestrian in Ashfield is injured in a car accident, resulting in a spinal nerve-root injury. The injury causes neurological signs, such as numbness and weakness, but not radiculopathy. Under SIRA’s guidelines, this may still qualify as a threshold injury eligible for care support. The injured person would need to provide medical evidence confirming the injury’s link to the accident and demonstrate the need for assistance with daily tasks.
Next steps
If you are in Ashfield and need to claim care or family support under NSW CTP rules, ensure you gather all required evidence and submit your claim within the 52-week timeframe. If you face challenges with SIRA’s assessment, seek legal advice to explore your options. Every claim depends on its own facts, and the availability of support can vary based on the injury’s severity and circumstances.
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