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 you're disputing care costs for domestic duties in a New South Wales Compulsory Third Party (CTP) claim, understanding the legal process is critical. Under the Motor Accident Injuries Act 2017, claimants may seek compensation for household tasks like cooking, cleaning, or shopping if their injuries limit daily functioning. Disputes over the amount or necessity of these services often arise, requiring structured resolution. This article explains how to address such disagreements using NSW’s formal processes.
How SIRA Guides Domestic Duties Claims
The State Insurance Regulatory Authority (SIRA) oversees CTP claims in NSW. Its guidelines clarify that domestic duties care costs are payable if the injury prevents the claimant from performing these tasks. SIRA’s What You Can Claim page confirms that such support is available for injuries that reduce daily capacity, including soft-tissue injuries meeting the threshold under the Motor Accident Guidelines.
Disputes typically occur when claimants or insurers disagree on the scope of care needed. SIRA advises resolving such conflicts through its internal review process, which includes written submissions and, if necessary, a formal review by the Personal Injury Commission. This pathway ensures claims are assessed against medical evidence and statutory criteria.
Practical Steps for Addressing Disputes
- Document the care needs: Keep records of how the injury impacts daily tasks, including medical reports from general practitioners or specialists. For example, a doctor’s note stating reduced mobility due to a soft-tissue injury may justify household assistance.
- Submit a written dispute: Under NSW CTP rules, claimants can request a review of their care cost assessment by writing to SIRA. This should outline why the current valuation is incorrect, referencing medical evidence.
- Engage in mediation: SIRA’s dispute resolution process may include a mediation step, where a neutral party assesses the claim. This avoids the need for formal legal action unless the dispute escalates.
- Appeal to the Personal Injury Commission: If the dispute remains unresolved, claimants may appeal to the Personal Injury Commission, which has the authority to review decisions under the Motor Accident Injuries Act 2017. This body considers whether the care costs align with the injury’s severity and functional limitations.
Time Limits and When to Seek Advice
CTP claims must be submitted within 52 weeks of the accident, though disputes over care costs may extend beyond this period. If a claimant believes their care needs have worsened after this timeframe, they may need to pursue a separate review under the Act’s provisions for “consequences” of the injury. However, delays can weaken a claim, so seeking legal advice early is advisable.
A key consideration is that disputes over domestic duties care costs are not automatically resolved in the claimant’s favor. SIRA emphasizes that all claims must be supported by medical evidence and meet the statutory definition of “threshold injury” under the Motor Accident Guidelines. If the injury does not meet this threshold, care costs may be denied or limited.
Example: Resolving a Care Cost Dispute
Consider a claimant who suffered a soft-tissue injury in a car accident. Their doctor notes reduced mobility, making it difficult to prepare meals or manage household tasks. The insurer initially approves a limited care cost, but the claimant disputes this, arguing the injury’s impact is greater. By submitting detailed medical records and a written review request, the claimant can challenge the decision. If unresolved, the Personal Injury Commission may reassess the claim based on updated evidence.
Next Steps for Claimants
Disputes over domestic duties care costs in NSW CTP claims require a structured approach. While SIRA provides internal review mechanisms, claimants should act promptly to ensure their case is evaluated within the law’s time limits. If you’re facing a disagreement over care costs, completing the quick, no obligation enquiry form can help you connect with a professional to explore your options.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.