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).
Highway merge accidents often result in injuries requiring ongoing care, placing a financial and emotional burden on families. In New South Wales, the Compulsory Third Party (CTP) insurance scheme covers certain caregiver and family support costs for eligible claims. This article explains what expenses may be claimable, how insurers assess support needs, and the documentation required to support a claim following a highway merge collision.
What Caregiver Expenses Are Covered Under NSW CTP Laws?
Under the Motor Accident Injuries Act 2017, CTP insurers must cover reasonable costs for assistance with daily living activities if an injury prevents a person from performing them independently. This includes:
- Personal care (e.g., bathing, dressing, eating)
- Mobility support (e.g., wheelchair assistance, transport to medical appointments)
- Household tasks (e.g., cooking, cleaning, laundry)
- Medical equipment (e.g., crutches, mobility aids)
However, CTP does not cover all family-related expenses. Expenses like:
- Childcare costs (unless the injured person is a parent and the child is under 12)
- Funeral expenses
- Mental health therapy for the injured person
- Travel costs for family members (unless specifically required by a medical professional)
are generally not claimable. Insurers will assess whether the expense is directly related to the injury and necessary for the injured person's recovery.
How Do Insurers Assess Family Support Needs?
Insurers evaluate the need for family support by reviewing:
- Medical evidence from a treating doctor confirming the injury's impact on daily living
- Caregiver's role (e.g., full-time or part-time assistance, frequency of care)
- Specific needs (e.g., assistance with toileting, medication management)
- Financial impact on the family (e.g., lost income, additional living costs)
For example, if a family member must leave work to provide 24-hour care, the insurer may consider the lost income as part of the claim. However, the claimant must provide payslips or employer statements to substantiate this.
Documentation Required for Caregiver-Related Claims
To support a CTP claim for family support costs, claimants must provide:
- Medical reports detailing the injury's effect on daily living
- Caregiver's evidence of need (e.g., doctor's note confirming the injured person requires assistance)
- Receipts or invoices for medical equipment, home modifications, or other approved expenses
- Proof of income loss for family members providing care (e.g., payslips, tax returns)
- Accident details (e.g., police report, witness statements, photographs of the scene)
Insurers may also request a care plan from a medical practitioner outlining the injured person's needs and the proposed support arrangements.
Time Limits and Dispute Resolution
CTP claims must be submitted within 52 weeks of the accident if the injury is classified as a threshold injury (i.e., a soft tissue injury meeting specific medical criteria). For more severe injuries, there is no strict time limit, but delays may affect the ability to claim certain benefits.
If an insurer disputes the claim, claimants can:
- Request a review of the decision in writing
- Seek mediation through the NSW Civil and Administrative Tribunal (NCAT)
- Appeal to the Supreme Court if necessary
It is important to act quickly, as delays in submitting evidence may result in reduced compensation or denied claims.
When to Seek Legal Advice
Families should consider consulting a solicitor if:
- The insurer denies the claim without a clear explanation
- The claimant is unsure whether an expense is claimable
- There are disputes over the amount of compensation
- The injured person requires long-term care
A lawyer can help ensure all documentation is complete and that the claimant understands their rights under the CTP scheme.
Conclusion
Highway merge accidents can have lasting impacts on both the injured person and their family. While NSW CTP insurance covers some caregiver-related costs, claimants must provide detailed evidence to support their case. Understanding the legal framework and documentation requirements is essential to securing fair compensation. Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.