What is a PIC application under the NSW CTP scheme?
A Personal Injury Commission (PIC) application is a formal process to resolve disputes about entitlements under the NSW Compulsory Third Party (CTP) insurance scheme. It is used when a claimant disagrees with a decision made by an insurer, such as a denial of benefits, a refusal to pay for treatment, or a dispute about the amount of compensation. In Bega and throughout NSW, the PIC is the independent body that hears and determines these disputes. The process is available to anyone who has suffered injury in a motor accident, including family members and caregivers who have provided care as a result of the injury.
Who may apply for a PIC claim as a caregiver or family member?
A caregiver or family member may apply for a PIC claim if they have provided care to an injured person as a direct result of a motor accident. This includes unpaid family members who have spent time assisting with daily tasks such as cooking, cleaning, personal care, or transporting the injured person to medical appointments. The law allows for claims by carers who have not been injured themselves, provided they can demonstrate that they have provided substantial care and that this care has caused them personal hardship or financial loss.
The claim must relate to a motor accident that occurred in NSW. The accident must have happened on or after 1 January 2017, as the Motor Accident Injuries Act 2017 governs CTP claims from that date. The claimant must have been a carer for the injured person for a continuous period following the accident, and the care must have been necessary due to the injury.
What documentation is required for a PIC application involving a family member?
To support a PIC application, the applicant must provide evidence that establishes the nature and extent of the care provided. Key documents include:
- A completed and signed care log detailing the hours spent on care tasks, the date of each activity, and a description of the assistance provided.
- A medical certificate from the injured person’s treating medical practitioner confirming the need for ongoing care and the level of dependency.
- A written statement from the injured person confirming that the caregiver has provided assistance and describing the impact of the injury on daily life.
- Evidence of financial loss, such as a payslip showing reduced work hours, a letter from an employer confirming unpaid leave, or a record of out-of-pocket expenses related to care (e.g. transport, equipment).
If the caregiver is not a direct family member but has a close personal relationship, a statutory declaration may be required to confirm the nature of the relationship and the care provided.
How does SIRA’s guidance apply to caregiver-focused PIC claims in Bega?
The State Insurance Regulatory Authority (SIRA) provides guidance on how PIC applications are assessed, including for carers and family members. SIRA’s position is that carers are entitled to claim for the time and effort they have invested in supporting an injured person, particularly where that care has disrupted their normal life or resulted in financial loss.
SIRA’s Motor Accident Claims website confirms that carers may claim for time spent providing care, but only if the care was necessary and not provided as part of a paid role. The claim is not for compensation for emotional distress, but for the actual time and effort expended. The maximum amount that can be claimed for care is capped under the Motor Accident Injuries Act 2017, and the claim must be supported by verifiable records.
In Bega, as in all NSW regions, the PIC process is conducted online or by post, and applicants are expected to submit all documentation within 12 months of the insurer’s decision. SIRA’s guidance also notes that if the injured person has a threshold injury (such as a soft tissue injury not meeting the threshold for damages), the carer’s claim may still proceed, but the benefits available will be limited to treatment and care, and weekly payments.
Practical steps and time limits for PIC applications in Bega
The first step in a PIC application is to notify the insurer of the dispute in writing, clearly stating the grounds for disagreement. This must be done within 12 months of receiving the insurer’s decision. If the insurer does not respond within 28 days, the applicant may proceed directly to the PIC.
After lodging the application, the PIC will assign a case officer who will review the evidence and may request additional information. The process can take several months, and parties may attend a hearing if an agreement cannot be reached.
A practical example: A mother in Bega provided daily care for her teenage son after he was injured in a car accident. He required help with personal hygiene, meal preparation, and transport to physiotherapy. She worked part-time and reduced her hours to support him. After her claim for care was denied, she submitted a care log, medical reports, and a statement from her son. The PIC accepted her claim and awarded a lump sum for care hours based on the national average hourly rate for unpaid care.
When to seek independent advice
While the PIC process is designed to be accessible, the legal and evidentiary requirements can be complex. A caregiver may not fully understand what constitutes a valid claim, how to structure a care log, or how to respond to a request for further information. It is advisable to seek independent legal advice if:
- The insurer has denied the claim and the reasons are unclear.
- The claim involves a disputed injury or a claim for a large amount of care time.
- The injured person has a pre-existing condition that may affect the claim.
The NSW Legal Aid website and local community legal centres may provide free advice. However, the PIC process does not require a solicitor to participate.
Next steps
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.