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).
Pillion passengers injured in NSW motor accidents may require ongoing care, creating unique challenges for families. Under the NSW Compulsory Third Party (CTP) scheme, caregivers and dependants can claim financial support for related expenses. This article explains how families navigate CTP claims, including SIRA's role in assessing caregiver needs, available benefits, and practical steps to take.
Key CTP Claims for Pillion Passengers
The NSW CTP scheme provides financial support for injuries sustained in motor vehicle accidents, including for pillion passengers. Caregivers and families may claim:
- Weekly income support for the injured person's lost earnings
- Treatment and care benefits to cover medical and rehabilitation costs
- Caregiver allowances for family members providing daily assistance
- Dependant support for children or elderly relatives reliant on the injured person
SIRA (State Insurance Regulatory Authority) oversees these claims, ensuring payments align with the Motor Accident Injuries Act 2017 and guidelines. Families must demonstrate the injured person's need for ongoing care and the caregiver's role in meeting that need.
SIRA's Role in Assessing Family Considerations
SIRA evaluates claims by considering:
- The injured person's medical condition and expected recovery time
- The nature of caregiving duties (e.g., mobility assistance, medication management)
- The financial impact on the family, including lost income and out-of-pocket expenses
- Whether the injured person is unable to work or perform daily tasks
SIRA uses the Motor Accident Guidelines to determine if a claimant qualifies for additional benefits. For example, a pillion passenger with a spinal nerve-root injury meeting specific clinical criteria may be eligible for extended treatment payments.
Essential Documentation for Caregiver Claims
To support a CTP claim involving a caregiver, families should gather:
- Medical records confirming the injured person's condition and care requirements
- A care plan outlining daily assistance needed (e.g., mobility aids, personal hygiene)
- Proof of income loss for the injured person and caregiver (e.g., payslips, tax returns)
- Witness statements or letters from healthcare professionals
- Accident reports and police statements to establish fault and circumstances
Families must submit these documents to SIRA within 52 weeks of the accident to claim weekly benefits. After this period, benefits may be limited to treatment costs unless the injured person has a whole person impairment rating of 10% or more.
CTP Reforms and Caregiver Compensation
Recent CTP reforms have clarified that caregiver claims are separate from the injured person's own compensation. Families should be aware of:
- Time limits: Claims must be submitted within 52 weeks for weekly benefits, though some benefits may be claimed beyond this period
- Dispute resolution: If SIRA rejects a claim, families can request a review or seek mediation through the NSW Civil and Administrative Tribunal (NCAT)
- Overlap with workers' compensation: If the injured person is also covered by workers' compensation, benefits may be adjusted to avoid double recovery
A hypothetical example illustrates this: A pillion passenger with a soft-tissue injury requiring 24/7 caregiving may receive weekly income support for 52 weeks. After this period, the family could claim treatment benefits for ongoing physiotherapy, provided the injury meets the threshold injury criteria under the Motor Accident Guidelines.
When to Seek Legal Advice
Families should consult a solicitor if:
- SIRA denies a claim despite clear evidence of caregiving needs
- The injured person's condition worsens, requiring additional support
- There are disputes over fault or insurance coverage
- The family needs help navigating the 52-week time limit for weekly benefits
Legal professionals can help families understand their rights under the Motor Accident Injuries Act 2017 and ensure all evidence is properly submitted.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.