Who Can Claim for Treatment and Rehabilitation After a Fatal Motor Accident?
In New South Wales, a claim for treatment and rehabilitation benefits following a fatal motor accident can be made by a person who was financially dependent on the deceased, or by the legal personal representative of the deceased’s estate. These benefits are not paid to the deceased but may be claimed on their behalf if they were receiving or required treatment at the time of death. The claim is governed by the Motor Accident Injuries Act 2017 (MAIA), which applies to all motor accidents occurring on or after 1 December 2017. The State Insurance Regulatory Authority (SIRA) administers the scheme and assesses claims for compensation.
What Treatment and Rehabilitation Benefits Are Available?
Treatment and rehabilitation benefits cover reasonable and necessary medical, psychological, and care services that were required as a result of injuries sustained in the accident. These benefits may include:
- Medical treatment and rehabilitation services
- Psychological support
- Care and assistance services
- Mobility aids, home modifications, and other reasonable support
The claim must be supported by medical evidence showing that the treatment was directly related to injuries from the accident. A formal care plan from a qualified health professional, including recommendations for ongoing care, is required to establish the need for continued services. These benefits are not available if the deceased was not receiving or required treatment at the time of death.
Evidence Required to Support a Claim
To establish a claim for treatment and rehabilitation benefits, the following evidence is typically needed:
- Medical records showing treatment received by the deceased prior to death
- A formal assessment of care needs, including a plan from a health professional
- Proof of financial dependency, such as tax returns, household expense records, or a statement from the deceased’s employer
- A death certificate and a copy of the will or letters of administration
- Documentation of any funeral or burial expenses not covered by insurance or government assistance
Photographs of the accident scene, witness statements, and a police report may also be useful to establish the circumstances of the accident, particularly if there is a dispute about fault or the nature of the injuries.
Time Limits for Making a Claim
A claim for treatment and rehabilitation benefits must generally be made within three years of the date of death. This time limit applies to claims made by a financial dependent or the estate representative. The executor or administrator of the estate must act promptly to preserve rights. Missing the deadline may result in the claim being barred.
It is also important to notify the insurer as soon as possible after the accident, particularly if ongoing care was required. Delays in providing documentation may affect the approval of benefits.
How SIRA Assesses Claims
SIRA assesses whether the treatment was reasonable and necessary, and whether it was directly related to injuries from the accident. The assessment considers the nature and severity of the injuries, the treatment plan, and the medical evidence. If a claim is rejected or the offered amount is disputed, the claimant may request a review by SIRA. If the review is unsuccessful, the claimant may apply to the Civil and Administrative Tribunal (NCAT) for a determination.
When Independent Advice May Be Useful
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.