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).
In New South Wales, care and family support claims under the Compulsory Third Party (CTP) scheme cover essential costs for injured individuals and their dependants. This includes expenses for unpaid care, assistance with daily living, and support during rehabilitation. In the Newcastle and Hunter regions, claimants must understand how the NSW CTP framework evaluates these claims and what evidence is required to support them.
What Types of Care and Family Support Costs Are Covered?
Under the Motor Accident Injuries Act 2017, care and family support claims cover both paid and unpaid care needs arising from a motor accident. This includes:
- Costs for assistance with personal care (e.g., bathing, dressing)
- Expenses for mobility support (e.g., wheelchairs, walking aids)
- Support for household tasks (e.g., cooking, cleaning)
- Costs of family members reducing work hours or leaving employment to provide care
- Rehabilitation-related expenses (e.g., physiotherapy, occupational therapy)
SIRA (State Insurance Regulatory Authority) assesses these claims based on medical evidence and the injured person's specific needs. For example, if a child requires full-time care due to a serious injury, the claim may include costs for a carer's wages and transportation.
How SIRA Evaluates Care and Family Support Claims
SIRA uses a structured approach to determine the level of care needed. Key factors include:
- Medical reports confirming the injury's impact on daily living
- A care and rehabilitation plan from a medical practitioner
- Evidence of the injured person's ability to perform essential tasks
- Documentation of family members' financial contributions to care
In the Newcastle and Hunter region, claimants should ensure their care plan includes:
- A detailed assessment from a registered nurse or physiotherapist
- Records of the injured person's pre-accident level of independence
- Proof of any changes in mobility, cognition, or daily living skills
A hypothetical example: If a motorcyclist sustains a spinal injury requiring 24/7 care, SIRA would evaluate medical records showing the injury's severity, the care plan outlining specific needs, and evidence of the family's financial sacrifice.
Documentation Required for Care and Family Support Claims
To support a claim, injured individuals must provide:
- Police reports or accident statements
- Medical records from hospitals or GPs
- Care and rehabilitation plans from medical practitioners
- Proof of income for family members providing unpaid care
- Receipts for paid care services (e.g., home help, transport)
In Newcastle and Hunter, claimants should also gather evidence of how the injury has affected their ability to work or perform daily tasks. This may include employment records, witness statements, and statements from family members.
Time Limits and When to Seek Advice
CTP claims must be submitted within 52 weeks of the accident for certain benefits. However, claims for care and family support can be made at any time if the injury is a 'threshold injury' (as defined by the Motor Accident Guidelines). If a claim is disputed, claimants should seek legal advice promptly to challenge decisions.
In the Newcastle and Hunter region, claimants should contact SIRA directly or consult a solicitor if they face delays or rejections. Independent legal advice is particularly important if the claim involves complex rehabilitation needs or disputes over care requirements.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.