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).
If a person dies as a result of a motor accident in New South Wales, their dependants may be eligible for financial support through the Compulsory Third Party (CTP) insurance scheme. This support includes funding for treatment and care costs incurred by a dependant who sustained injuries in the same accident that caused the death. This funding is available under the Motor Accident Injuries Act 2017 and is administered by the State Insurance Regulatory Authority (SIRA). The support is not automatic and depends on the nature of the injuries, the claimant’s relationship to the deceased, and the timing of the claim.
How Treatment Costs Are Funded for Dependants
A dependant who suffered injuries in a motor accident that resulted in a death may be entitled to treatment and care benefits under the CTP scheme. These benefits cover reasonable and necessary medical, surgical, and allied health treatment, including rehabilitation, therapy, and ongoing care. The funding is not limited to the deceased’s medical expenses but extends to any dependant who was injured in the same incident and continues to require treatment.
To qualify, the dependant must have been injured in the accident, and the injury must be related to the motor vehicle event. The treatment must be clinically appropriate and supported by a medical practitioner’s report. Funding is provided through the CTP insurer responsible for the vehicle that caused the accident, or through the Nominal Defendant if the insurer is not available.
Who Qualifies as a Dependant for CTP Funding
A dependant under the CTP scheme includes a spouse, de facto partner, child, or other person financially dependent on the deceased at the time of death. The claim for treatment costs must be made by the injured dependant, not by the estate of the deceased. The claimant must demonstrate that they were financially reliant on the deceased and that their injuries occurred in the same accident.
For example, if a mother and her teenage daughter were passengers in a car that collided with a truck, and the mother died from her injuries, the daughter may be eligible for treatment and care benefits if she sustained injuries in the crash. The daughter would need to provide medical evidence of her injuries and proof of her financial dependence on her mother to support her claim.
Evidence and Documentation Required
To support a claim for treatment costs, the injured dependant must provide:
- A medical report from a treating practitioner detailing the nature, extent, and ongoing need for treatment
- Itemised invoices or receipts for medical services, medications, or equipment
- Evidence of financial dependence on the deceased, such as tax returns, household expense records, or a written statement
- A completed claim form, available through SIRA or the CTP insurer
Photographs of injuries, accident scene details, and witness statements may also be helpful, particularly if there is a dispute about the cause of the injuries or the timing of treatment.
Time Limits and Procedural Requirements
There is no fixed time limit for making a claim for treatment and care benefits as a dependant, but it is advisable to begin the process as soon as possible after the accident. Delays may affect the availability of evidence or the ability to obtain timely treatment. The claim must be made within the standard timeframes for CTP claims, which are generally 3 years from the date of the accident, unless a claim for damages is involved.
If the claim is disputed, the injured dependant may request a review from SIRA or apply to the Civil and Administrative Tribunal (NCAT) for a determination. However, if the injury is a threshold injury, benefits may be limited to 52 weeks unless the claim proceeds to damages.
Differences from Other CTP Claim Types
This funding pathway differs from claims made by the deceased’s estate for funeral expenses or from a common law damages claim. It also differs from claims made by a surviving driver or passenger who was not a dependant. The treatment cost funding for dependants is not part of the estate’s claim and is not subject to the same thresholds as damages claims. It is a standalone entitlement under the CTP scheme for those who were injured and financially dependent on the deceased.
When to Seek Legal Advice
While the CTP scheme provides a framework for funding treatment costs, the process of gathering evidence, completing forms, and dealing with insurers can be complex. In Greater Sydney and surrounding areas, the volume of claims and insurer practices vary, which may affect the outcome. It is advisable to seek independent advice if:
- The claim for treatment costs is denied or delayed
- There is uncertainty about financial dependence or injury causation
- The claim involves a complex injury or long-term treatment needs
Next Steps
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.