Understanding death benefits for dependants in NSW CTP claims
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).
When a person dies as a result of a motor accident in New South Wales, their dependants may be eligible to claim financial support through the Compulsory Third Party (CTP) insurance scheme. This support includes funding for reasonable and necessary treatment costs incurred by the dependants as a result of injuries sustained in the accident, even if those injuries were not fatal. The CTP scheme, administered by the State Insurance Regulatory Authority (SIRA), provides this support under the Motor Accident Injuries Act 2017 and the Motor Accident Injuries Regulation 2017.
Dependants may include a spouse, child, or other person financially dependent on the deceased at the time of death. The claim for treatment costs must be made under the same CTP claim as the deceased’s original injury claim. If the deceased had not yet made a claim, a dependant may still initiate a claim on their behalf, provided they can demonstrate financial dependency and that treatment was necessary and reasonable.
How treatment costs are funded under a death benefit claim
Funding for treatment costs under a CTP death benefit claim is not automatic. It is subject to the same eligibility criteria that apply to any CTP claim for treatment and care benefits. These benefits cover reasonable and necessary medical, allied health, and rehabilitation services received after the accident.
To qualify, the treatment must have been received within a reasonable timeframe after the accident and must be directly related to injuries sustained in the motor accident. The claim must be supported by medical evidence, including treatment records, prescriptions, and invoices from health practitioners. The insurer will assess whether the treatment was appropriate and whether the costs were reasonable.
In Albury and across NSW, treatment costs may include physiotherapy, psychological counselling, specialist consultations, and medication. The CTP insurer is responsible for paying these costs, provided the claim is made within the applicable time limits and supported by sufficient evidence.
Key legal distinctions and limitations
It is important to distinguish between death benefits and other CTP claims. Death benefits under the CTP scheme are not a separate entitlement but are part of the broader CTP compensation framework. The right to claim treatment costs for dependants arises only if the dependant was injured in the accident and required treatment. If the dependant was not injured, they cannot claim treatment costs under the CTP scheme, even if they are a financial dependant of the deceased.
The Motor Accident Injuries Act 2017 limits the availability of damages for non-fatal injuries to cases where the claimant has a threshold injury. However, this threshold does not apply to claims made by dependants for treatment costs. The focus is on whether the treatment was reasonable and necessary, not on whether the injury meets a threshold for damages.
Where a dependant was injured in the accident and received treatment, the claim for funding must be made through the CTP insurer of the at-fault vehicle. If the at-fault driver was not insured, or if the insurer disputes the claim, the dependant may apply to SIRA for a determination.
Practical steps and evidence to support a claim
To seek funding for treatment costs under a CTP death benefit claim, the following steps are recommended:
- Obtain and retain all medical records, including treatment notes, prescriptions, and invoices from healthcare providers.
- Identify and contact any witnesses to the accident, and obtain their contact details.
- Preserve any photographs of injuries, property damage, or the accident scene.
- Notify the CTP insurer as soon as possible after treatment begins, and keep copies of all correspondence.
- If the claim is disputed, request a formal review from the insurer or apply to SIRA for a determination.
In Albury, as in the rest of NSW, claims for treatment costs must be made within the time limits set under the Motor Accident Injuries Act 2017. While the general time limit for making a claim is three years from the date of the accident, it is advisable to act promptly to preserve evidence and avoid delays in processing.
When to seek independent advice
The legal framework for CTP claims involving dependants and treatment costs is complex. Factors such as the nature of the injury, the timing of treatment, and the financial dependency relationship can affect eligibility. Disputes may arise over whether treatment was reasonable or whether the claimant was truly dependent on the deceased.
A hypothetical example: A 32-year-old mother in Albury was injured in a motor accident that resulted in her death. Her 8-year-old daughter, who was a passenger, sustained a back injury and required ongoing physiotherapy and psychological support. The daughter’s treatment costs were funded through the CTP claim initiated by the family’s legal representative, based on medical evidence and proof of financial dependency.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.