Death benefits for dependants, understanding insurer decisions in rural and remote NSW
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 a motor accident results in a fatality, dependants such as children, partners or parents may be eligible for death benefits under New South Wales’ Compulsory Third Party (CTP) scheme. However, insurers often make decisions about these claims based on specific legal criteria, and rural or remote locations can influence how claims are assessed. This article explains the legal framework, practical steps for dependants, and how to challenge unfair decisions.
Legal rules behind death benefits for dependants
Under the Motor Accident Injuries Act 2017, death benefits are available to dependants of a person killed in a motor accident. The New South Wales government’s State Insurance Regulatory Authority (SIRA) administers these claims. To qualify, the dependant must demonstrate a financial or domestic reliance on the deceased. This includes:
- Children under 18 or students under 25
- Partners or spouses who relied on the deceased’s income
- Parents or guardians who relied on the deceased’s support
Insurers assess claims based on the Motor Accident Guidelines and SIRA’s published criteria. For example, a dependant must prove they were financially dependent on the deceased at the time of the accident. This is typically done through:
- Income records of the deceased
- Evidence of the dependant’s financial reliance (e.g., school enrollment, household responsibilities)
- Medical or psychological records showing dependency
How rural and remote locations affect insurer decisions
Insurers in rural and remote NSW may evaluate claims differently due to challenges such as limited access to medical services, longer travel times for witnesses, or delays in obtaining documentation. For instance:
- A dependant in a remote area may struggle to provide timely medical records, which could impact the insurer’s assessment of dependency
- Insurers may scrutinise claims more closely if evidence is incomplete due to location-related barriers
SIRA advises dependants to submit all available evidence promptly, including:
- Police reports from the accident scene
- Witness statements from local communities
- School or employment records
Practical steps for dependants seeking death benefits
If you are a dependant seeking death benefits, take these steps:
- Notify the insurer promptly, SIRA requires claims to be submitted within 52 weeks of the accident, though exceptions may apply for dependants with ongoing needs
- Gather evidence of dependency, This includes:
- Proof of the deceased’s income
- Evidence of your financial reliance (e.g., bank statements, school records)
- Medical records showing the deceased’s health or support role
- Seek independent medical or financial advice, If the insurer disputes your claim, a specialist report from a registered medical practitioner may be necessary
- Challenge unfair decisions, If your claim is denied, you can request a review through SIRA or seek legal advice. Insurers must provide written reasons for rejections under the Motor Accident Injuries Act 2017.
Example: How location impacts claim assessment
Consider a scenario where a farmer’s wife dies in a rural motor accident. Her 16-year-old son, who relied on his mother’s income for university tuition, claims death benefits. The insurer may:
- Question the son’s financial reliance if he has not provided proof of tuition costs
- Delay processing due to limited access to local financial records
In such cases, dependants should:
- Submit evidence from local schools or financial institutions
- Seek assistance from SIRA’s claims support team
When to seek legal advice
Insurers may deny claims based on technicalities, such as:
- Failing to meet the
- threshold injury* criteria for dependants
- Not providing sufficient evidence of dependency
- Misinterpreting the 52-week time limit for benefits
If your claim is denied, it is important to seek legal advice to challenge the decision. Legal professionals can help you:
- Request a review of the insurer’s decision
- Submit additional evidence
- Understand your rights under the
- Motor Accident Injuries Act 2017*
Next steps for dependants
Understanding how insurers assess death benefits in rural and remote NSW requires awareness of both legal criteria and practical challenges. If you are unsure whether your claim meets the requirements, or if your claim has been denied, it is important to seek professional advice. General information cannot determine whether a claim is available in an individual case. To request contact about your circumstances, complete the quick, no obligation enquiry form.