Baseline function and additional care needs
Can CTP cover extra care if I already had a disability?
Potentially - the claim can address additional needs caused by the accident
A pre-existing disability does not exclude a NSW CTP personal injury claim. The insurer should distinguish the claimant’s pre-accident support and function from the additional treatment, care, equipment or assistance reasonably required because of the motor accident. The claim cannot duplicate care already required for an unrelated condition, but it should not ignore a genuine accident-related increase merely because support existed before the crash.
The comparison is individual. A claimant may already have needed help with some tasks but become less able to transfer, shower, cook, travel, communicate or participate in the community after the accident. Another claimant may need different equipment, more frequent assistance or temporary support during recovery.
Clear baseline evidence is essential. It protects against both overstatement and an insurer assumption that every post-accident need was pre-existing. Treating and occupational evidence should identify the change, accident causation, service requested and review plan.
Reviewed by Herman Chan, Stephen Young Lawyers
How is the pre-accident baseline established?
Useful material can include disability service plans, care rosters, occupational therapy reports, equipment records, GP and specialist notes, family evidence and the claimant’s ordinary activities. The baseline should describe what support was actually used, not only what funding was theoretically available.
The post-accident comparison should identify new assistance, increased hours, changed techniques, temporary substitute care, equipment replacement or reduced independence. It should also record recovery and changing needs so the request remains proportionate.
What treatment and care can the CTP insurer consider?
The insurer considers whether treatment and care is reasonable, necessary and related to the motor accident. A request should specify the service or item, frequency, provider, goals, cost and why existing support does not meet the accident-related need. Coordination may be required with the NDIS, health system, private insurance or another payer, but coordination does not justify leaving a necessary request undecided.
Family-provided assistance may evidence the functional change, yet reimbursement or funded care is not automatic. Obtain an occupational or treating assessment that identifies the task, amount, duration and clinical reason instead of relying only on a family estimate.
How do pre-existing impairment and damages differ from care?
A permanent impairment assessment considers the impairment caused by the motor accident and may require a reasoned deduction for a genuine pre-existing impairment under the Motor Accident Guidelines. A diagnosis, age or imaging finding does not justify an arbitrary deduction. The assessor must use the applicable method and evidence.
Common law damages have separate fault, injury and loss requirements. Treatment and care acceptance does not automatically establish damages. The greater-than-10% WPI test is specifically significant for non-economic loss, while threshold injury classification is a different legal question.
Practical next steps
How should increased care needs be presented?
Use a transparent before-and-after comparison supported by service and clinical records.
Document the baseline
Collect pre-accident care plans, rosters, equipment, function reports and ordinary activity evidence.
Record the post-accident change
Identify each new task, extra time, altered support or lost independence and when it began.
Obtain a specific assessment
Ask the treating practitioner or occupational therapist to connect the additional need to the accident and state frequency, duration and goals.
Identify other funding clearly
Provide NDIS, insurer or service information so responsibility can be coordinated without duplicate payment.
Request a written insurer decision
If care is reduced or refused, ask for the exact reason, evidence relied on and available review process.
Evidence
Evidence checklist for increased care
The file should permit a reliable comparison between established baseline support and accident-related change.
- Pre-accident care plans, service agreements, rosters and invoices.
- Pre-accident OT, physiotherapy, medical and functional reports.
- Post-accident OT or treating assessment of additional tasks and hours.
- A task-by-task comparison of independence, assistance, equipment and safety.
- Family or support-worker records documenting the actual change without double counting.
- Equipment quotes, trial reports and reasons existing equipment is no longer adequate.
- NDIS or other funding records relevant to coordination and baseline services.
- Insurer treatment-and-care decision and the material relied on.
Common problems in increased-care claims
- Do not present all existing disability support as if it began with the accident.
- Do not let the insurer treat every new need as pre-existing merely because the claimant already received assistance.
- Avoid duplicate claims to different payers for the same service and period.
- A family estimate of hours is useful history but may not replace a clinical task assessment.
- A pre-existing condition does not justify an unsupported WPI deduction; the assessor must apply the current Guidelines method.
Timing
Claim and care-decision timing
Lodge the claim promptly and request urgent support where delay creates a safety or discharge problem.
- The general period for lodging a statutory personal injury benefits claim is three months after the motor accident.
- Lodgement within 28 days is significant if weekly payments are sought from the day after the accident; a later claim requires an explanation and may affect backdating.
- Police reporting is generally required within 28 days unless police attended.
- A care refusal or reduction should be checked promptly for internal review and PIC rights. The written decision and dispute type determine the procedure.
Frequently asked questions
- Can the insurer refuse care because I have NDIS funding?
- The existence of another funding source does not answer whether the requested service is accident-related and payable under CTP. Responsibility and duplication must be coordinated on the evidence.
- What if family provided all care before and after the accident?
- Document the actual tasks and time before and after. A clinical assessment can identify any accident-related increase and whether formal support is reasonable and necessary.
- Can CTP replace damaged disability equipment?
- Ordinary property damage is not the same as CTP treatment and care. An accident-related clinical need for equipment may be considered, but damage to an item can also raise a separate property claim.
- Will my pre-existing disability reduce WPI automatically?
- No. Any deduction must follow the Motor Accident Guidelines and be supported by evidence of genuine pre-existing impairment, not merely a diagnosis or age-related change.
- Can a retired or non-working person receive care benefits?
- Potentially. Treatment and care are assessed separately from weekly income-replacement benefits. Lack of wages does not itself exclude reasonable and necessary accident-related care.
- What if my needs will change again?
- The assessment can identify immediate, transitional and longer-term needs with review points. Update the insurer when function or treatment materially changes.
Related NSW CTP guides
Official sources
- Motor Accident Injuries Act 2017 (NSW), current in-force version
- SIRA Motor Accident Guidelines, current published version
- SIRA guide for people injured in motor accidents in NSW
- Service NSW: apply for personal injury benefits after a motor vehicle accident
The legislation and SIRA material linked above are the public-source basis for this page. Medical and legal conclusions depend on the accident date, the current law, the insurer decision and the evidence in the individual claim.
Baseline and additional needs
Has the insurer treated new care needs as pre-existing?
Send the decision, pre-accident care plan and current assessment. We can identify the baseline, accident-related change and evidence needed for review.
General information only: This page is about the NSW motor accidents scheme and is not legal or medical advice. It does not promise claim acceptance, treatment approval, weekly payments or damages. Urgent symptoms require prompt advice from an appropriate health practitioner.