Children injured as pedestrians in driveway accidents may face challenges returning to daily activities. Under NSW Compulsory Third Party (CTP) rules, insurers assess recovery based on medical evidence and functional outcomes. This article explains how CTP claims evaluate daily activity recovery for children, the evidence required, and when families should seek legal advice.
How NSW CTP Insurers Assess Daily Activity Recovery
NSW CTP insurers evaluate a child's ability to return to daily activities by examining medical records, treatment progress, and functional capacity. The Motor Accident Injuries Act 2017 (s 4.4) limits benefits after 52 weeks if injuries are classified as 'threshold injuries', minor injuries like soft tissue damage or minor fractures. Insurers rely on SIRA's guidelines to determine whether a child can resume school, play, or household tasks.
Key factors include:
- Medical reports detailing recovery milestones
- Evidence of functional limitations (e.g., difficulty walking, coordination issues)
- Statements from teachers or caregivers about changes in behavior or activity levels
- Rehabilitation records showing progress toward pre-accident function
Insurers may also consider whether the child's daily activities have been permanently affected, which could influence long-term benefits.
Evidence Required for Daily Activity Claims
To support a claim about daily activity recovery, families should gather:
- Detailed medical records from doctors, physiotherapists, and psychologists
- School reports or teacher notes about changes in academic performance or behavior
- Activity logs tracking the child's ability to walk, run, or engage in play
- Statements from family members describing pre-accident and current activity levels
- Rehabilitation plans or therapy progress reports
SIRA's guidance emphasizes that insurers must consider the child's 'whole person impairment', not just physical injuries. For example, a child with anxiety from the accident may struggle with school attendance, which could affect benefits.
Time Limits and Dispute Options
CTP claims must be submitted within 52 weeks of the accident if the injury is classified as a threshold injury. After this period, weekly benefits and treatment payments generally stop unless the child has a 'whole person impairment' of 10% or more. Families should act quickly to ensure they meet deadlines.
If an insurer disputes a claim, families can request a review by the NSW Civil and Administrative Tribunal (NCAT) or seek independent medical opinions. SIRA provides templates for disputing decisions, which can be accessed through their website.
When to Seek Legal Advice
Families should consult a solicitor if:
- The child's injuries exceed threshold injuries (e.g., significant whiplash or concussion)
- The insurer refuses to pay for necessary treatment or equipment
- The child's daily activities have been permanently impacted
- The 52-week deadline is approaching and benefits are at risk of being cut off
Legal professionals can help navigate complex claims, challenge unfair decisions, and ensure families receive all entitled benefits.
Practical Example
Consider a 7-year-old child who fell in a driveway and developed a fear of walking. Medical records show no physical injury, but the child refuses to walk to school. SIRA guidelines would assess whether this fear constitutes a functional limitation affecting daily activities. If so, the child may qualify for ongoing benefits beyond 52 weeks.
Next Steps
CTP entitlements depend on the accident date, injury type, and claim timing. Families should act promptly to gather evidence and meet deadlines. For personalized advice, complete the quick, no obligation enquiry form to request contact about your circumstances.