Understanding the 10% Impairment Threshold in NSW CTP Claims
In New South Wales, a person who suffers a motor vehicle accident may be eligible for compensation through the Compulsory Third Party (CTP) insurance scheme. To access certain benefits, including those that may support a caregiver, the injured person must meet a legal threshold. Under the Motor Accident Injuries Act 2017, this is a minimum of 10% whole person impairment. This threshold applies to injuries that are classified as threshold injuries, which include soft tissue injuries and certain psychological or psychiatric injuries that are not recognised psychiatric illnesses, such as adjustment disorder or acute stress disorder.
The 10% threshold is not a measure of pain or inconvenience. It is a legal requirement that must be established by a medical practitioner using the criteria set out in the Motor Accident Guidelines. The assessment considers the permanent loss of physical or mental function resulting from the accident. If the injury does not meet this threshold, the injured person may not be entitled to damages or certain financial benefits, and caregiver support may not be available.
How Caregiver Support Is Determined in NSW
A caregiver may be eligible for financial support if the injured person has a permanent impairment of at least 10% and the care provided is directly related to that impairment. The support is not automatic and must be demonstrated through evidence. The care must be necessary because of the injury, not because of general family responsibilities.
SIRA (State Insurance Regulatory Authority) assesses claims based on medical evidence, including reports from treating medical practitioners and independent assessors. The assessment considers whether the injury has caused a permanent loss of function that affects the injured person’s ability to perform daily activities independently. For example, if a person with a 12% impairment to the lower limb requires assistance with mobility, bathing, or household tasks, and this need arises directly from the injury, the caregiver may be eligible for a payment.
Evidence Required to Support a Caregiver Claim
To establish a claim for caregiver support, the following evidence is typically required:
- A medical report confirming the injury and the 10% or higher whole person impairment
- A documented care plan outlining the type, frequency, and duration of care provided
- Records of time spent on care activities, including dates and tasks performed
- Evidence of financial impact on the caregiver, such as lost income or out-of-pocket expenses
- A statement from the injured person confirming the need for care
The care must be reasonable and necessary. SIRA will not consider care that is disproportionate to the injury or that could have been provided by a paid service. The claim must show that the care is not available through other sources, such as family members not involved in the claim or government support programs.
Important Time Limits and Procedural Steps
A claim for compensation must be made within 52 weeks of the motor accident. This deadline applies to all aspects of the claim, including notifying the insurer and requesting a SIRA assessment. If the injury is a threshold injury, and the only injuries are threshold injuries, weekly benefits and treatment and care benefits generally cease after 52 weeks, as provided under sections 3.11 and 3.28 of the Motor Accident Injuries Act 2017.
For caregivers, it is essential to act promptly. Delaying the claim may result in the loss of entitlements. The injured person must notify their insurer as soon as possible after the accident. The caregiver should keep detailed records of care provided from the date of the accident. These records are critical to proving the need for ongoing support.
When to Seek Independent Advice
Disputes over impairment assessments are common. If a medical assessment concludes that the injury does not meet the 10% threshold, or if the insurer denies a claim for caregiver support, the injured person or caregiver may request a review. An independent medical assessment may be necessary to challenge the initial opinion.
Legal advice is recommended if the claim is denied, the assessment is disputed, or the evidence is unclear. A solicitor with experience in NSW CTP claims can help gather and present evidence, negotiate with insurers, and, if necessary, apply for a review or proceed to a tribunal.
Example Scenario
A 62-year-old woman in Auburn was injured in a car accident. She sustained a soft tissue injury to her left leg, which was assessed as a 12% whole person impairment. The injury has resulted in permanent mobility limitations, and she requires daily assistance with walking, bathing, and household tasks. Her daughter, who lives with her, provides this care. The daughter has incurred out-of-pocket expenses and has reduced her work hours to manage the care. Because the injury meets the 10% threshold and the care is directly related to the injury, the daughter may be eligible for a caregiver payment under the CTP scheme.
Next Steps
Every claim depends on its own facts. The availability of caregiver support depends on the injury type, the impairment assessment, the nature of the care provided, and the evidence collected. To request contact about your circumstances, complete the quick, no obligation enquiry form.