Can CTP pay for attendant care, home nursing or respite?

An occupational therapist, nurse or other qualified assessor may examine personal care, mobility, cognition, behaviour, supervision, domestic activity, risk and existing supports. A care recommendation should separate active assistance, prompting, supervision, standby time, nursing tasks and ordinary household work. It should also explain night care, weekends, variability and any expected reduction as recovery progresses.

The insurer should consider less restrictive and cost-effective alternatives without compromising safety. Equipment, home modification, rehabilitation or task redesign may reduce some care hours, but those alternatives must be realistic and available. A theoretical aid does not replace care if it has not been trialled or the person cannot use it safely.

Keep paid rosters and invoices consistent with the assessed tasks. Large unexplained differences between recommended and invoiced hours can create disputes. If needs fluctuate, record why, such as treatment days, fatigue, falls, behavioural episodes or changes in the home environment.

Section 3.25 says statutory benefits are not payable for gratuitous attendant care services, defined as services provided without payment and without liability to pay. A family member’s assistance can still be important evidence of the need, but hours of unpaid help do not automatically become a reimbursable statutory benefit.

Where a family member is genuinely employed or engaged to provide paid care, the arrangement, qualifications, rate, tax and payment evidence should be clear. Merely writing retrospective invoices does not necessarily establish a genuine liability or a reasonable rate. Professional nursing tasks may require an appropriately qualified provider regardless of family willingness.

Section 3.26 separately deals with some paid domestic services for dependants where strict conditions are met. Do not use that provision as a substitute for care required by the injured person, and do not mix the hours in a single total.

For a person in the ordinary 2017 CTP scheme, the licensed insurer generally manages treatment and care during the first five years. Long-term treatment and care may transfer to icare CTP Care after five years, with the Lifetime Care and Support Authority becoming the relevant insurer for those expenses. The licensed insurer can remain responsible for other claim issues, including a separate damages claim.

The Lifetime Care and Support Scheme is different. It supports eligible people with catastrophic injuries under its own participation rules. Section 3.32 prevents duplicate ordinary CTP treatment benefits for needs covered by Lifetime Care. A person should not assume that serious care needs automatically establish Lifetime Care eligibility or that CTP Care and Lifetime Care are the same program.

If the responsible scheme is unclear, ask for written confirmation before changing providers or cancelling services. Transfer should include current approvals, service agreements, invoices, reports and a named contact so necessary care is not lost in administration.