Where a person's only injuries resulting from the accident are threshold injuries, weekly benefits and treatment and care generally cease after 52 weeks (ss 3.11 and 3.28).
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).
Traumatic brain injuries (TBIs) can severely impact daily activities, and under NSW Compulsory Third Party (CTP) laws, injured people may claim compensation for limitations caused by a motor accident. This guide explains how CTP covers daily activity restrictions, what evidence is needed, and practical steps for TBI survivors in Ashfield NSW.
What CTP Claims Cover for Daily Activities
Under the Motor Accident Injuries Act 2017, CTP insurance covers treatment, income loss, and daily activity limitations caused by a motor accident. For TBIs, this includes:
- Rehabilitation support to restore daily living skills
- Compensation for tasks like cooking, dressing, or managing finances
- Coverage of assistive devices or home modifications
The NSW CTP scheme recognises that TBIs often cause long-term functional impairments. For example, a person with memory loss from a TBI may need help with medication management, which could qualify as a daily activity limitation under the scheme.
Documenting Daily Activity Limitations
To claim compensation for daily activity restrictions, you must:
- Keep detailed records of how the injury affects your ability to perform routine tasks
- Obtain medical documentation linking the TBI to specific activity limitations
- Track changes in your capacity over time
Evidence may include:
- Doctor's reports detailing cognitive or physical restrictions
- Statements from family or carers about daily challenges
- Before-and-after activity logs (e.g., cooking times, memory test results)
A TBI survivor in Ashfield who struggles to prepare meals due to executive function impairments would need to document this with a dietitian's assessment and a GP's opinion on how the injury impacts daily living.
Time Limits and Dispute Resolution
CTP claims must be made within 52 weeks of the accident for most benefits. However, claims for daily activity limitations may extend beyond this period if:
- The injury is classified as a 'threshold injury' under the Motor Accident Guidelines
- The claimant requires ongoing support for daily living
Disputes over daily activity claims are resolved through the NSW Civil and Administrative Tribunal (NCAT). If an insurer refuses a claim, you can request a review or apply for a formal hearing. For example, a TBI claimant denied for needing help with personal hygiene could challenge this by providing a psychologist's report on functional impairments.
When to Seek Legal Advice
While some claims can be managed through SIRA's online portal, complex TBI cases often require legal assistance. A solicitor can:
- Help navigate the 52-week statutory benefit rules
- Challenge incorrect assessments of daily activity limitations
- Ensure all evidence is properly submitted
If your TBI has caused long-term daily activity restrictions, it's important to act promptly. Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.