How SIRA evaluates care and family support claims under NSW CTP laws
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 has suffered a serious road injury in Bankstown, you may be eligible for care and family support benefits under NSW's Compulsory Third Party (CTP) scheme. SIRA (State Insurance Regulatory Authority) administers these claims, and its guidelines determine whether you qualify for compensation. This article explains how SIRA defines eligible care needs, how it assesses family support claims, and the key differences between these claims and other CTP benefits.
What SIRA considers as eligible care and family support claims
Under the Motor Accident Injuries Act 2017, SIRA provides benefits for care needs and family support when a motor accident results in a 'threshold injury' or higher. A threshold injury is defined as an injury that meets specific medical criteria, such as a spinal nerve-root injury producing neurological signs. For care claims, SIRA evaluates whether the injured person requires assistance with daily living tasks like personal hygiene, mobility, or meal preparation.
Family support claims cover the cost of unpaid care provided by a family member. SIRA assesses these claims by considering the time and effort required to care for the injured person, including the impact on the carer's employment or education. For example, if a family member needs to take time off work to provide care, SIRA may award compensation for lost income.
How SIRA determines compensation for family support
SIRA uses a structured approach to calculate family support payments. It considers the type of care needed, the number of hours required, and the carer's circumstances. For instance, if a family member provides 20 hours of care per week, SIRA may award a weekly payment based on the carer's income level and the cost of professional care.
The compensation also accounts for the emotional and psychological impact of caregiving. SIRA's guidelines emphasize that family support claims must demonstrate a direct link between the injury and the care needs. This includes medical evidence confirming the injury's severity and documentation of the carer's role.
Key differences between family support and other CTP claims
SIRA's family support rules differ from other CTP claim categories, such as treatment and care benefits or weekly income payments. While treatment benefits cover medical expenses, family support specifically addresses the cost of unpaid care. Additionally, family support claims are not available if the injured person's care needs are fully met by a professional carer.
Another distinction is the 52-week rule. If your injury is classified as a threshold injury, SIRA may limit benefits after 52 weeks. However, family support claims can continue beyond this period if the care needs persist and meet the threshold criteria.
Practical steps to support your claim
To strengthen your care or family support claim, gather the following evidence:
- Medical records confirming the injury's severity and care needs
- A care assessment report from a registered nurse or physiotherapist
- Proof of your or your family member's income, such as payslips or tax returns
- Witness statements or photographs of the accident scene
- Documentation of any impact on your employment or education due to caregiving
SIRA also requires a 'care plan' outlining the type and frequency of care needed. This plan should be prepared by a healthcare professional and submitted with your claim.
Time limits and dispute resolution
You have 52 weeks from the date of the accident to claim weekly benefits for threshold injuries. However, family support claims may have different time limits depending on the injury's nature. Always check with SIRA to confirm the deadline for your specific case.
If your claim is denied or you disagree with the outcome, you can request a review through SIRA's internal process. For further disputes, the NSW Civil and Administrative Tribunal (NCAT) can review your case. SIRA's guidelines outline the steps for lodging a review, which are available on its website.
When to seek legal advice
SIRA's rules can be complex, especially when determining the extent of care needs or the impact on family members. If your claim involves multiple injuries, long-term care requirements, or disputes over compensation, consider consulting a legal professional. A solicitor can help ensure your claim meets all SIRA criteria and that you receive the support you're entitled to.
Next steps
CTP entitlements depend on the accident date, injury type, and claim history. To request contact about your circumstances, complete the quick, no obligation enquiry form.