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).
E-scooter collisions in New South Wales can leave families grappling with medical bills, lost income, and daily care needs. Under NSW’s Compulsory Third Party (CTP) scheme, caregivers and families may be eligible for support to cover these costs. This article explains what caregiver expenses are covered, how insurers assess family support claims, and the practical steps families should take following an e-scooter collision.
What Caregiver Expenses Are Covered Under NSW CTP Claims?
NSW CTP insurers cover specific expenses related to caregiving for injured claimants. These include:
- Medical treatment costs for the injured person, such as hospital visits, specialist consultations, and prescribed medications.
- Lost income for family members who must take time off work to provide care.
- Daily living assistance costs, like hiring a domestic helper or purchasing mobility aids.
- Transportation expenses for medical appointments or therapy sessions.
SIRA’s What you can claim page confirms that these expenses are recoverable under the CTP scheme, provided they are directly related to the injury caused by the collision.
How Do Insurers Assess Family Support Claims?
Insurers evaluate family support claims based on documented evidence and the injured person’s medical records. Key factors include:
- Medical reports confirming the injured person’s need for ongoing care.
- Proof of income loss for caregivers, such as payslips or employer statements.
- Receipts or invoices for caregiving expenses, like transportation or home help.
- Witness statements from family members or friends detailing the caregiving role.
SIRA guidelines emphasize that claims must demonstrate a direct link between the injury and the caregiving costs. For example, if a family member must leave work to care for an injured cyclist, the insurer will assess the lost income based on their employment history.
Practical Steps for Families Managing CTP Claims
Families should take the following steps to ensure their claims are processed smoothly:
- Document all caregiving expenses immediately, including receipts, invoices, and bank statements.
- Keep medical records up-to-date, as they are critical evidence for proving the need for care.
- Notify the at-fault driver’s insurer as soon as possible to initiate the claims process.
- Seek independent medical opinions if the insurer disputes the severity of the injury.
- Consult a legal professional if the claim is denied or if disputes arise over the amount of support.
Time Limits and Dispute Resolution
NSW CTP claims must be submitted within five years of the accident, as per the Motor Accident Injuries Act 2017. However, certain benefits, like weekly income payments, are limited to 52 weeks if the injury is classified as a threshold injury (a minor soft-tissue injury). Families should be aware that claims involving long-term care or significant impairment may have different timeframes.
If an insurer disputes a family support claim, the process involves:
- Submitting a written objection to the insurer.
- Requesting a review by SIRA’s dispute resolution team.
- Pursuing mediation or legal action if necessary.
A Hypothetical Example
Consider a family where a parent is injured in an e-scooter collision and requires daily assistance. The family member must take time off work to care for the injured person, resulting in lost income. The insurer assesses the claim by reviewing the injured person’s medical records, the caregiver’s employment history, and receipts for home help. If the claim is approved, the family receives compensation for both the injured person’s treatment and the caregiver’s lost income.
When to Seek Legal Advice
Families should seek legal advice if:
- The insurer denies the claim without a clear explanation.
- The claim involves complex medical conditions or long-term care needs.
- The family is unsure whether their caregiving expenses are covered.
Legal professionals can help families navigate the CTP process, challenge unfair denials, and ensure they receive all available support.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.