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).
In New South Wales, funeral expenses incurred due to a motor accident are covered under the Compulsory Third Party (CTP) scheme, but insurers assess claims based on specific rules. This article explains what funeral costs are eligible, how insurers evaluate claims, and steps to improve approval chances in Greater Sydney.
What Funeral Expenses Are Covered Under NSW CTP Claims?
Under the Motor Accident Injuries Act 2017, funeral expenses are a recoverable cost under the CTP scheme. This includes:
- Funeral home fees for arranging the burial or cremation
- Transportation costs for the deceased to the funeral location
- Costs of clothing or other items for the deceased
- Fees for a memorial service or other related costs
Insurers typically cover up to the cost of a standard funeral, but the exact amount depends on the evidence provided. For example, if a family chooses a more expensive service, the insurer may dispute the claim unless there is evidence of necessity.
How Do Insurers Assess Funeral Expenses Claims in NSW?
Insurers evaluate funeral expense claims based on:
- Documentation: Receipts, invoices, and written evidence from funeral homes or service providers
- Reasonableness: Whether the costs align with standard funeral arrangements in the local area
- Necessity: Whether the expenses were essential to the funeral service
- SIRA guidelines: The State Insurance Regulatory Authority (SIRA) provides detailed criteria for what is considered a recoverable cost
For instance, an insurer might reject a claim for a custom casket if it exceeds the cost of a standard casket unless there is evidence of a medical or cultural requirement.
Factors Influencing an Insurer's Decision
Several factors affect how insurers handle funeral expense claims:
- Type of funeral: Burial vs. cremation costs may vary significantly
- Location: Funeral home rates in Sydney may differ from regional areas
- Evidence quality: Clear, itemised invoices are more likely to be approved
- Claim timing: Delays in submitting evidence may affect the outcome
Insurers may also consider the deceased’s circumstances, such as whether they had a known preference for a specific type of service.
Practical Steps to Improve Approval Chances
To increase the likelihood of approval, claimants should:
- Keep detailed records: Retain all invoices, receipts, and correspondence with funeral providers
- Document the necessity: Provide evidence of why specific costs were incurred (e.g., a medical reason for a particular service)
- a Submit evidence promptly: Delays may lead to claims being rejected as 'out of time'
- Request a review: If an insurer denies a claim, you can ask for a written explanation and appeal through SIRA
For example, a family in Sydney who submitted a funeral home invoice showing a standard cremation cost was approved, while a claim for a custom memorial service was denied due to lack of evidence.
Time Limits and Dispute Options
CTP claims must generally be submitted within 52 weeks of the accident, but funeral expense claims are treated as one-time costs. If an insurer denies a claim, you can:
- Request a written explanation from the insurer
- Lodge a complaint with SIRA
- Seek legal advice if the decision seems unfair
It is important to act quickly, as delays can reduce the chances of a successful outcome.
When to Seek Legal Advice
If an insurer denies a funeral expense claim or disputes the amount, it may be necessary to consult a legal professional. A lawyer can help:
- Challenge the insurer's decision based on the evidence
- Navigate the claims process with SIRA
- Explore options for dispute resolution
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.