Domestic duties care costs under NSW CTP: Understanding insurer decisions
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 injured in a motor accident in New South Wales and need help with household tasks like cooking, cleaning or shopping, you may be eligible for domestic duties care costs under the NSW Compulsory Third Party (CTP) scheme. However, insurers assess these claims based on strict legal rules. This article explains how insurers evaluate domestic duties care costs, what factors they consider, and how to challenge decisions in regional NSW.
Legal framework for domestic duties care costs
The NSW CTP scheme covers care costs for injured claimants who need assistance with daily living. Under the Motor Accident Injuries Act 2017, domestic duties care costs are defined as expenses incurred to help a person perform household tasks they can no longer do due to their injury. This includes:
- Cleaning and laundry
- Meal preparation and shopping
- Child or pet care
- Transportation to medical appointments
Insurers must consider these costs as part of the claim, but they are not automatically approved. The Motor Accident Guidelines outline how to assess the necessity and extent of care required. For example, the guidelines specify that care must be 'reasonably necessary' and directly related to the injury.
How insurers assess domestic duties care claims
Insurers evaluate domestic duties care claims by considering:
- Medical evidence: Doctors must confirm the injury limits the claimant's ability to perform household tasks. For instance, a back injury that prevents lifting heavy objects may justify meal preparation assistance.
- Nature of the task: Insurers assess whether the task is essential for daily living. For example, a claimant who can still cook simple meals may not qualify for full-time assistance.
- Duration of need: The claimant must demonstrate the care is needed for a specific period. The Motor Accident Injuries Act 2017 s 4.4 limits benefits after 52 weeks if the injury is a 'threshold injury' (a minor injury meeting specific medical criteria).
- Cost justification: Insurers require evidence of actual expenses, such as receipts for hired help or a diary tracking time spent on tasks.
Practical steps for claimants in regional NSW
In regional areas, claimants may face additional challenges accessing medical professionals or legal advice. To support your claim:
- Keep a detailed diary: Record daily tasks you cannot perform and how they impact your life.
- Obtain medical reports: Ensure your doctor explicitly links your injury to the need for domestic duties care.
- Request a review: If your claim is denied, ask the insurer to provide written reasons. You may also seek a review by the NSW Civil and Administrative Tribunal (NCAT).
Challenging insurer decisions
If an insurer rejects your domestic duties care claim, you have options:
- Submit additional evidence: Provide new medical opinions or documentation showing the need for care.
- Appeal to NCAT: You can apply to the NCAT for a review of the insurer's decision. This process is available in regional NSW and does not require a solicitor.
- Seek independent advice: A legal professional can help you understand your options and prepare a stronger case.
Example: How an insurer might assess a claim
Consider a claimant who suffered a back injury in a car accident. They cannot lift groceries and need help with meal preparation. The insurer would:
- Review the doctor's report to confirm the injury limits lifting.
- Assess whether meal preparation is a 'domestic duty' under the CTP scheme.
- Determine the cost of hiring assistance and whether it aligns with the claimant's needs.
If the insurer denies the claim, the claimant could challenge the decision by providing additional evidence, such as a specialist opinion linking the injury to the need for care.
Next steps
Domestic duties care costs under NSW CTP depend on the injury's impact, medical evidence, and the insurer's interpretation of the law. If you're in regional NSW and need help understanding an adverse decision, contact a legal professional. Every claim depends on its own facts.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.