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).
NSW CTP insurers assess domestic duties care costs by evaluating medical necessity, evidence of daily functional limitations, and alignment with SIRA guidelines. This guide explains how insurers determine eligibility, what evidence matters, and steps to challenge decisions.
Legal Framework for Domestic Duties Claims
Under the Motor Accident Injuries Act 2017, domestic duties care costs are considered a valid claim if they result from a threshold injury. SIRA’s Motor Accident Claims guidelines outline that care costs must be 'reasonably necessary' to support the injured person’s daily living. Insurers assess whether the tasks (e.g., cooking, cleaning, personal care) are directly linked to the injury’s impact on functionality.
Key Factors in Insurer Decisions
Insurers evaluate:
- Medical evidence: Reports from medical practitioners confirming functional limitations.
- Care provider documentation: Evidence that the care is performed by a registered carer or family member.
- Necessity of tasks: Whether the tasks are essential due to the injury, not lifestyle choices.
- SIRA guidelines: Alignment with the What You Can Claim framework, which specifies eligible support types.
For example, if a claimant requires assistance with meal preparation due to hand injuries, insurers will check if this task is medically necessary and if there’s evidence of reduced functional capacity.
Practical Steps for Claimants
To support a domestic duties claim:
- Document the injury’s impact on daily activities.
- Obtain medical reports linking the injury to functional limitations.
- Keep records of care arrangements, including provider details and task lists.
- Submit evidence to the insurer within the 52-week statutory period for threshold injuries.
Insurers may reject claims if the care is deemed non-essential or if evidence is insufficient. Claimants should review SIRA’s Making a Motor Accident Claim guide for submission requirements.
Time Limits and Dispute Options
CTP claims must be submitted within 52 weeks of the accident for threshold injuries. If an insurer denies domestic duties costs, claimants can:
- Request a review through SIRA’s internal process.
- Seek independent medical opinions to challenge the insurer’s assessment.
- Escalate to the NSW Civil and Administrative Tribunal (NCAT) if disputes persist.
When to Seek Legal Advice
Claimants should consult a solicitor if:
- The insurer’s decision is unclear or contradicts medical evidence.
- The claimant is unsure how to challenge a rejection.
- There are disputes over the scope of eligible care tasks.
Next Steps
CTP insurers evaluate domestic duties care costs based on strict medical and evidentiary standards. Understanding these criteria can help claimants prepare stronger submissions. If you need assistance with your claim, complete the quick, no obligation enquiry form to request contact about your circumstances.