How SIRA interprets care and family support claims under NSW CTP rules
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).
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've suffered a serious motor vehicle accident on the Central Coast and need care or family support, the NSW Compulsory Third Party (CTP) scheme may cover your costs. SIRA (State Insurance Regulatory Authority) administers the CTP scheme and provides detailed guidance on what qualifies as a care or family support claim. This article explains how SIRA applies the rules to claims on the Central Coast.
What types of care and family support are covered under CTP?
Under the Motor Accident Injuries Act 2017, CTP claims cover care and family support if the injury meets the 'threshold injury' definition. This includes:
- Paid care (e.g., nursing, physiotherapy, or domestic help)
- Unpaid family support (e.g., a spouse or child providing care)
- Specialist equipment or home modifications
SIRA's guidelines state that care must be 'reasonably necessary' due to the injury. For family support, the claimant must demonstrate that the injury has significantly impacted their ability to work or perform daily tasks.
How SIRA determines eligibility on the Central Coast
SIRA applies the same national CTP rules across NSW, including the Central Coast. Key factors include:
- Medical evidence: A doctor must confirm the injury meets the threshold definition (e.g., via a spinal nerve-root injury with neurological signs). SIRA's Motor Accident Guidelines outline clinical signs for threshold injuries.
- Care necessity: SIRA assesses whether the care is 'reasonably necessary' by considering medical reports, care plans, and the claimant's functional capacity.
- Financial impact: For unpaid family support, SIRA evaluates whether the injury has caused a significant loss of income or ability to work.
A hypothetical example: If a cyclist on the Central Coast suffers a soft-tissue injury requiring 24/7 nursing care, SIRA would review medical records to confirm the injury meets the threshold and assess whether the care is essential for recovery.
Documentation required for claims
To support a care or family support claim, you'll need:
- Medical records confirming the injury and care needs
- Evidence of financial impact (e.g., income statements, tax returns)
- Care provider invoices or quotes
- A care plan from a medical practitioner
- Witness statements or accident reports (if relevant)
SIRA may request additional documentation if the claim is complex. It's important to submit all evidence promptly to avoid delays.
Time limits and when to seek advice
CTP claims must be submitted within 52 weeks of the accident for certain benefits. If your claim involves disputes over care needs or eligibility, you may need to:
- Request a review from SIRA
- Seek independent medical opinions
- Consult a legal professional if benefits are denied
If you're unsure whether your care or family support needs qualify, contact SIRA directly or complete the quick, no obligation enquiry form for guidance.
Next steps
Understanding how SIRA applies CTP rules on the Central Coast requires attention to medical evidence, care necessity, and financial impact. If your claim involves disputes, time limits, or complex circumstances, it's important to seek professional advice. Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.