Hospital Discharge Planning for CTP Claims
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).
When a family member is injured in a motor accident and discharged from hospital, caregivers must understand how to support recovery while meeting legal and administrative requirements under NSW's Compulsory Third Party (CTP) scheme. This includes documenting care needs, coordinating with insurers, and ensuring medical records support the claim.
Key CTP Rules for Discharge Planning
Under the Motor Accident Injuries Act 2017, CTP insurers must cover treatment, care, and income support for eligible injuries. For discharge planning, caregivers should:
- Record daily care needs: Document assistance with mobility, medication, or personal hygiene to demonstrate ongoing care requirements.
- Share medical advice: Ensure doctors note how injuries affect daily activities, as this influences claims for treatment and income benefits.
- Communicate with insurers: Inform insurers of changes in care plans, as delays or unreported needs may affect benefit approvals.
Practical Steps for Families
Caregivers should take these actions during hospital discharge:
- Gather medical records showing injury severity and recovery timelines.
- Note how injuries impact household responsibilities, such as cooking or cleaning.
- Request a care plan from healthcare providers to outline support needs.
- Keep copies of all correspondence with insurers or SIRA.
For example, if a cyclist is discharged with a soft-tissue injury requiring 24-hour care, caregivers must prove how this affects their ability to work or manage household tasks. This evidence supports claims for weekly income benefits under the CTP scheme.
Time Limits and Dispute Resolution
CTP insurers must respond to claims within 28 days under the Motor Accident Injuries Regulation 2017. If benefits are denied, families can:
- Request a review from the insurer's internal team.
- Seek mediation through the NSW Civil and Administrative Tribunal (NCAT) if disputes persist.
The 52-week statutory benefit period applies to injuries meeting the 'threshold injury' definition under the Motor Accident Guidelines. After this period, weekly income benefits may stop unless the injury meets higher impairment criteria.
When to Seek Legal Advice
Families should consult a solicitor if:
- The insurer refuses to cover essential care costs.
- Medical records are unclear about injury impact.
- Disputes over benefit amounts or payment delays occur.
Legal advice can help ensure caregivers meet all requirements for treatment benefits and income support under the CTP scheme.
Next Steps
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.