Understanding Care and Family Support in NSW CTP Claims
If you have sustained a serious injury in a motor accident in Greater Sydney, you may be entitled to compensation for care and family support needs under the NSW Compulsory Third Party (CTP) insurance scheme. This support is not limited to paid care services. It includes assistance from family members or friends who provide care without payment, as well as formal care arrangements. The scheme recognises that serious injuries can significantly affect your ability to perform daily tasks, and that family members may need to reduce work hours or leave employment to provide care.
The Motor Accident Injuries Act 2017 (MAIA) and the Motor Accident Injuries Regulation 2017 set out the legal framework for these claims. SIRA, the State Insurance Regulatory Authority, administers the CTP scheme in NSW and provides guidance on how care and family support claims are assessed. These rules apply uniformly across Greater Sydney, including in areas such as Sydney CBD, North Shore, Eastern Suburbs, and Western Sydney.
What SIRA Means by Care and Family Support
Under the CTP scheme, care and family support refers to assistance you need because of your injury, including help with personal care, household tasks, and mobility. This can include tasks such as bathing, dressing, preparing meals, cleaning, and managing medications. The law distinguishes between two types of support:
- Paid care: Services provided by a qualified carer, such as a registered nurse or personal care worker, under a formal care plan.
- Unpaid care: Assistance provided by a family member, partner, or close friend who is not paid for their time.
SIRA’s guidance confirms that both forms of care can be claimed, provided they are necessary and reasonable in the context of your injury. The claim must be supported by evidence that your injury has caused a need for care that would not otherwise exist.
How SIRA Assesses Care and Family Support Claims
SIRA uses a structured approach to assess whether care and family support is compensable. The process involves verifying the nature and extent of your injury, the type of care required, and the actual time spent providing care. Key factors include:
- The medical evidence showing the impact of your injury on your ability to perform daily activities.
- A detailed care plan outlining the tasks you need help with, the frequency of assistance, and the duration.
- For unpaid care, a formal declaration from the carer detailing the hours spent providing care, the tasks performed, and the relationship to you.
SIRA will assess whether the care is reasonable and necessary based on your whole person impairment (WPI) and the Motor Accident Guidelines. If your injury results in a WPI of 10% or more, and you require care for a sustained period, you may be eligible for compensation. SIRA does not automatically accept claims based on family members’ willingness to help; the need for care must be clinically justified and proportionate to your functional limitations.
Practical Steps and Evidence That Matter
To support a claim for care and family support, you should gather the following evidence as soon as possible:
- Medical reports from your treating practitioner, including a functional capacity assessment.
- A care plan developed by a qualified allied health professional, such as an occupational therapist.
- A signed statement from the unpaid carer, detailing the hours worked per week, the tasks performed, and the duration of care.
- Records of any paid care services, including invoices and service provider details.
- Evidence of changes in your daily routine, such as a reduction in household management or inability to care for children.
In Greater Sydney, claimants have successfully obtained compensation for family members who reduced their work hours to provide care, particularly in cases involving spinal injuries, traumatic brain injury, or major orthopaedic trauma. The location of the accident does not affect eligibility, but the claim must be made through the correct CTP insurer or SIRA, depending on the circumstances.
Time Limits and When to Seek Advice
There is a 3-year time limit from the date of the motor accident to make a claim for care and family support under the CTP scheme. This applies to all claims in NSW, including Greater Sydney. If you are still receiving care or the carer is still providing support after 3 years, you may still be able to claim, but you must initiate the process within the time limit.
If your claim is denied or the amount offered is insufficient, you may request a review from SIRA. If the review is unsuccessful, you may apply to the NSW Civil and Administrative Tribunal (NCAT) for a determination. Disputes over the value of unpaid care, particularly where the carer was employed, are common and often require expert assessment.
A hypothetical example: A 45-year-old mother in the Northern Beaches sustained a spinal injury in a car accident. She now requires assistance with bathing, dressing, and household tasks. Her husband, a full-time teacher, reduced his work hours from 35 to 20 per week to provide care. A formal care plan and medical evidence confirmed the need for ongoing support. SIRA accepted the claim for both paid and unpaid care, calculating a weekly rate based on the average cost of care and the hours contributed by the husband.
Next Steps
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.