What Are My Statutory Benefit Entitlements?

What Are My Statutory Benefits Entitlements?

Motor vehicle accidents can be distressing and overwhelming, resulting in physical injuries, emotional trauma, and financial burdens. 


Injured accident victims have the right to make a claim for statutory benefits for a period of up to 52 weeks, irrespective of fault for the accident. 

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YOUR ENTITLEMENTS

Motor vehicle accident statutory benefits are a part of the NSW Compulsory Third Party (CTP) insurance scheme. They are designed to provide financial compensation for individuals who have suffered injuries in motor vehicle accidents, regardless of who was at fault.



For motor accidents occurring on or after 1 April 2023, the entitlement to statutory benefits to injured people who are “wholly or mostly at fault” or who have suffered a “threshold injury” is extended from 26 weeks to 52 weeks.

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WHAT CAN I CLAIM?

  • The cost of reasonable and necessary treatment for your accident-related injuries (eg doctor’s fees, physiotherapy accounts, medicine – prescription or over the counter) as well as travel to obtain that treatment;

  • The cost of care and assistance for you around the home caused by your accident-related injuries (eg nursing care, cleaning services, gardening assistance);

  • The cost of care for your dependents if you need that care because of your accident-related injuries (eg childcare);

  • Income support for lost wages or earnings because of your accident-related injuries. These payments do not include payment for loss of superannuation, sick leave or annual leave.

MEDICAL AND REHABILITATION EXPENSES

With the help and support of your doctors and allied health practitioners, you are going to have to be proactive in asking the CTP insurer for treatment and care – they may not volunteer it. Treatment covers a lot of things including doctors, physiotherapists, counsellors, medication (prescription and over the counter), rehabilitation and the like. Care includes help with things that you can no longer do because of your injuries such as cleaning the house or doing the washing and the ironing.


Injured accident victims are entitled to payment expenses associated with treatment and care to assist their recovery. These include:

Reasonable and Necessary Treatments

You may be reimbursed for expenses related to the treatment of your accident-related injuries. This includes doctors consultations, specialist consultations, radiology scans, surgical procedures, physiotherapy, counselling, pain management, medication.


Additionally, if you need to travel to obtain the required treatment, the associated travel expenses can also be covered.

Care and Assistance

If your injuries, physical or psychological, prevent you from performing your usual tasks at home, you may require additional care and assistance. The cost of services such as nursing care, cleaning services, or gardening assistance that you need in and around your home can be covered.

Care for Dependents

If your injuries, physical or psychological, affect your ability to provide the same level of care for your dependents as before the accident, you may be eligible for compensation to cover the cost of necessary care. 
This can include childcare expenses if you are struggling to provide the care you previously provided to your children due to your injuries.

Income Support for Lost Wages or Earnings

If your injuries, physical or psychological, have caused you to be unable to return to work or to work in a reduced capacity you may be eligible for income support to compensate for the lost wages or earnings.

Get the compensation you deserve with a successful statutory benefits claim application. Navigate the complexities with ease and support with CTP Claim Guide & Stacks Goudkamp.

AM I AN 'EARNER"?

Only an “earner” is permitted to make a claim for statutory weekly benefits.

An earner is defined by the legislation as being at least 15 years old and meeting one of the following conditions: being employed or self-employed for a minimum period before the accident (8 weeks immediately preceding the accident, at least 13 weeks during the previous year, or at least 26 weeks during the previous 2 years), not having permanently retired from all employment at the time of the accident, having entered into an employment arrangement or a self-employment agreement before the accident, or receiving payments for loss of earnings.

PRE ACCIDENT WEEKLY EARNINGS

Pre-accident weekly earnings is defined by the legislation as meaning “the weekly average of the gross earnings received by the earner as an earner during the 12 months immediately before the day on which the motor accident occurred”. 


In simple terms this means that a calculation is undertaken to obtain the average weekly gross sum earned in the 52 weeks immediately prior to the date of the accident.


You will be asked to provide a copy of your payslips for the 52 week period prior to the date of the accident to allow the CTP insurer to calculate your pre-accident weekly earning entitlement.


The CTP insurer is required to provide you with a written decision setting out the basis for its pre-accident weekly calculation. Check the insurer’s calculations – do you agree that what they are paying you is a reflection of what you are losing? There are time limits that apply to disputing the insurer’s decisions about your PAWE and the amount of your benefits.

INCOME SUPPORT PAYMENTS

Under this scheme, individuals can access various benefits depending on the circumstances surrounding their accident and the extent of their injuries.


To help with the financial stress suffered after being involved in an accident income support payments are available to injured accident victims as follows:

Benefits After 52 Weeks

For individuals who were not at fault or not mostly or wholly at fault in the accident and have sustained non-threshold injuries income benefits can be extended for up to two years.

Benefits After 2 Years

For individuals who were not at fault or not mostly or wholly at fault in the accident and have sustained non-threshold injuries income benefits can be extended for up to two years if you have lodged a common law lump sum damages claim.

PRE-ACCIDENT WEEKLY EARNINGS - PERIODS

By understanding how these weekly payments are calculated and the factors involved, individuals can better assess the financial assistance available to them during their recovery process. It is essential to be aware of the entitlement periods and the impact that the difference in pre- and post-accident earnings can have on the amount received.


Income support payments do not include payment for loss of superannuation, sick leave or annual leave


The amount to be paid by the CTP insurer is determined by specific "entitlement periods" and is calculated based on the difference between your pre-accident and post-accident weekly earnings. A summary of your entitlements is set out below:

PERIOD

CAPACITY TO WORK

ENTITLEMENTS

1 - 13 Weeks

Total or partial loss of capacity to work.

You are entitled to receive 95% of the difference between your pre-accident weekly earnings and your post-accident weekly earnings (if any)


If you are unable to work you are entitled to receive 95% of your pre-accident weekly earnings.

14 - 78 Weeks

Total loss of capacity to work

If you are unable to work you are entitled to receive 80% of your pre-accident weekly earnings.

14 - 78 Weeks

Partial loss of capacity to work

You are entitled to receive 85% of the difference between your pre-accident weekly earnings and your post-accident weekly earnings (if any).

After 78 Weeks

Total loss of capacity to work

If you are unable to work you are entitled to receive 80% of your pre-accident weekly earnings.

14 - 78 Weeks

Partial loss of capacity to work

You are entitled to receive 85% of the difference between your pre-accident weekly earnings and your post-accident weekly earnings (if any).

Up to 5 Years

Injured accident victims with a whole person impairment of greater than 10%

Injured accident victims with a whole person impairment of greater than 10% are eligible to continue to receive income payments for up to 5 years from the date of the accident if they lodge a lump sum common law damages claim.

Ready to lodge your CTP compensation claim? Reach out to the team at CTP Claim Guide and get the support you need throughout the process. We’re here to help!

TIME LIMITS

You must make your statutory benefits claim within three months of the date of the accident. While you can make a late statutory benefits claim, it will be more difficult for you to do so because you will need to explain why you did not make a claim in time.

 

If you are losing income or wages because of the injuries you sustained in the accident we strongly recommend that you make your claim within 28 days of the date of the accident in order to get your wage loss backdated to the date of the accident.

Frequently Asked Questions

  • Can I claim statutory benefits if I am at fault?

    Yes.


    Injured accident victims have the right to make a claim for statutory benefits for a period of up to 52 weeks, irrespective of fault for the accident. 

  • Do I need legal representation for my statutory benefits claim?

    Whether you were a driver, passenger, pedestrian, motorcycle rider, bicycle rider, or a dependent of a deceased victim, you may be entitled to compensation for your injuries and related expenses.


    You can certainly make a claim for statutory benefits without legal representation and you may have no problems at all with the CTP insurer during the initial stages. Others have difficulties and find resistance from the insurance company from the moment they make the claim. 


    We recommend engaging the assistance of an expert CTP lawyer from the very beginning of your claim.

  • What if the driver at fault was uninsured?

    You can still make a claim for statutory benefits through the Nominal Defendant scheme, which covers compensation for accidents involving uninsured or unidentified drivers.

  • What if I used sick leave to cover the cost of my lost wages?

    The fact you are using up sick leave is a matter for you and your employer to sort out because you may want to ‘repay’ that sick leave (after the Insurer pays you your statutory entitlements) and have it restored so that you can use it later on. For example, if you use 3 months of sick leave on this accident and in a year or two develop some other unrelated medical condition that requires you to take sick leave you may need the sick leave you are using now.


    Your doctor should be providing you with a certificate of fitness every 28 days and that needs to set out how you are progressing in terms of work hours and duties and what additional treatment you need.

CONTACT US 

Submit the form below and we will have one of our expert CTP lawyers reach out to learn more about you and your circumstances and see if you are eligible. Start the CTP claim process now to get the compensation you deserve.

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