How NSW CTP Insurance Covers Caregiver and Family Costs
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 caring for an injured family member after a motor accident in NSW, you may be eligible for financial support through the Compulsory Third Party (CTP) scheme. The Motor Accident Injuries Act 2017 and SIRA guidelines outline how caregiver and family-related expenses are handled in claims. This article explains what costs are covered, how to prove them, and practical steps for families.
What Types of Caregiver Costs Are Covered?
NSW CTP insurance covers treatment and care benefits under the Motor Accident Injuries Act 2017. This includes:
- Payment for a nominated caregiver’s time and effort
- Costs of home modifications or equipment to support care
- Expenses for medical equipment or therapy required for recovery
These benefits are available if the injured person’s injuries are classified as threshold injuries (as defined in the Motor Accident Guidelines). However, long-term or complex care needs may require additional steps.
Proving Caregiver Costs in a Claim
To claim caregiver support, you must provide:
- A caregiver’s statement detailing the time spent providing care
- Medical evidence confirming the injured person’s need for assistance
- Invoices or receipts for home modifications or equipment
- A care plan from a medical practitioner outlining the necessity of support
SIRA advises keeping detailed records of all caregiving activities, including dates, hours, and specific tasks performed.
Families with Multiple Injured Parties
If more than one family member is injured in the accident, the CTP insurer must assess each person’s injuries separately. For example, if a parent and child are both injured, the insurer must determine:
- Whether each injury meets the threshold injury criteria
- How caregiver costs for each person overlap or differ
In such cases, the insurer may need to allocate benefits proportionally or adjust claims based on the severity of each injury.
Long-Term Care Considerations
If the injured person requires ongoing care, the CTP insurer must assess:
- Whether the injury meets the whole person impairment threshold (at least 10% impairment) under the Motor Accident Guidelines
- Whether the injury is likely to result in permanent or long-term care needs
If the injury is not a threshold injury, the insurer may limit benefits after 52 weeks. However, if the injury meets the whole person impairment threshold, the insurer must consider long-term care costs under the Act.
Time Limits and When to Seek Advice
CTP claims must be submitted within five years of the accident date. However, treatment and care benefits must be claimed within five years of the injury date. Delays can result in lost entitlements, especially for long-term care needs.
If you’re unsure whether your family’s circumstances qualify, seek advice before the 52-week mark. SIRA recommends contacting the insurer within six weeks of the accident to avoid complications.
Example: How Caregiver Costs Work in Practice
Consider a scenario where a mother is injured in a car accident and requires full-time care. Her son, a full-time student, takes on caregiving duties. The insurer must assess:
- Whether the mother’s injury meets the threshold injury criteria
- Whether the son’s caregiving hours qualify for payment
- Whether the family’s financial situation affects benefit calculations
In this case, the insurer would calculate the son’s caregiver payment based on the mother’s injury severity and the time spent providing care.
Next Steps for Families
If you’re managing a CTP claim involving caregiver or family support costs, take these steps:
- Notify the insurer within six weeks of the accident
- Gather medical evidence confirming the need for care
- Document caregiving hours and expenses
- Seek independent advice if the claim is denied or disputed
Contact for Assistance
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.