Understanding CTP Claims for Pillion Passengers in NSW
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).
A pillion passenger injured in a motorcycle accident in New South Wales may be entitled to compensation through the Compulsory Third Party (CTP) insurance scheme. This includes support for medical treatment, lost income, and care needs. Families and caregivers play a critical role in managing the claim process, particularly when the injured person is unable to act on their own. The Motor Accident Injuries Act 2017 (MAIA) governs all CTP claims in NSW, including those involving pillion passengers, and sets out the types of benefits available and the requirements for claiming.
What Support Is Available to Families and Caregivers
Families and caregivers of injured pillion passengers may access several forms of support under the CTP scheme. The injured person can claim treatment and care benefits to cover the cost of medical treatment, rehabilitation, and home care. If the injury results in a loss of income, the injured person may also claim weekly income payments. These payments are not dependent on fault and are available regardless of who caused the accident.
Caregivers may also be eligible for a care recipient’s claim if they are providing unpaid care. The CTP scheme allows for a claim for care and domestic assistance, which can include help with daily tasks such as cooking, cleaning, and personal care. This support is assessed based on the actual time spent providing care and the level of assistance required. Families should keep records of care hours and tasks performed.
Practical Steps for Families Managing a CTP Claim
The first step for any family or caregiver is to ensure the injured person receives prompt medical attention. This not only supports recovery but also creates a documented record of the injury and treatment. Families should also preserve evidence such as photographs of the accident scene, witness contact details, and any police or accident report. These materials may help establish the circumstances of the accident, particularly if there is a dispute about fault.
Families must notify the CTP insurer as soon as possible. The claim must be made within the time limits set by law. For most claims, the time to make a claim is three years from the date of the accident. However, if the injury is not immediately apparent, the time limit may start from when the injury was first diagnosed. Families should not delay notifying the insurer, as delays may affect the ability to claim.
Medical records are essential. These should include diagnosis, treatment plans, and any assessments of impairment. The Motor Accident Injuries Regulation 2017 and the Motor Accident Guidelines set out the standards for assessing injuries. For example, a spinal nerve-root injury that causes neurological signs other than radiculopathy may still be considered a soft-tissue injury under the guidelines. This can affect whether the injury qualifies as a threshold injury, which in turn affects eligibility for damages.
Time Limits and When to Seek Advice
Time limits are critical in CTP claims. While the general time limit for making a claim is three years from the accident date, certain claims, such as those involving a threshold injury, may be subject to additional rules. If the only injuries sustained are threshold injuries, weekly benefits and treatment and care benefits are generally limited after 52 weeks, as provided under the MAIA. This means that long-term care needs may not be met under the CTP scheme beyond that point, and families may need to explore alternative support options.
Families should seek legal advice if there is a dispute about fault, if the insurer refuses to pay a claim, or if the injured person’s condition worsens over time. The CTP insurer may dispute the extent of the injury or the need for care. In such cases, a formal review or application to the NSW Civil and Administrative Tribunal (NCAT) may be necessary. Families should not assume that a claim will be accepted without review.
A realistic example: A 45-year-old pillion passenger in Sydney was injured in a collision on the M4 motorway. The injury was not immediately apparent, but a scan six weeks later revealed a spinal nerve-root injury with neurological signs. The family began recording daily care tasks. After 52 weeks, the insurer stopped treatment and care benefits, citing the 52-week limit for threshold injuries. The family sought advice and successfully argued that the injury was not purely soft-tissue due to the presence of neurological signs, allowing continued benefits.
Next Steps for Families in Greater Sydney
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.