Most people severely injured in a motor accident in NSW will be admitted to a major hospital.
At that point in time, the hospital will generally advise us if your injuries are likely to meet our eligibility criteria by completing a Severe Injury Advice form.
That form is the trigger for us to contact you and your family to start the application process.
To enable us to make a decision about your eligibility for the Lifetime Care and Support Scheme, we need information about the motor accident and your injuries. This may include information from police, ambulance, hospitals, and insurance companies.
You’ll be assisted by a coordinator and hospital staff in the process of getting your application together.
What to include in your application
A signed application form
Your application form should include a consent form signed by you or a guardian or family member which allows us to contact people such as doctors, police, ambulance and insurance companies who have information that might help us make a decision about your eligibility for the Scheme.
A police report
If you have one, include the police report for the motor accident with your application.
A medical certificate
A medical specialist should complete a medical certificate, which forms part of an application. Your treating specialist will usually complete and provide this.
If you have already left hospital and think you may be eligible for the Scheme, contact us on 1300 738 586 to find out more information about eligibility and how we can help you apply.
How your injury is assessed
Whether you’re eligible for the Scheme is partly determined by the severity of your injury.
As part of the application process, a medical specialist will need to complete a medical certificate to confirm the severity of your injury. For some injuries, there are additional assessment tools that need to be completed.
Below are the assessment tools we use for each type of injury covered by the Scheme:
- Brain injuries and burns: FIM and WeeFIM
- Spinal cord injuries: American Spinal Injury Association (ASIA) Scale
- Amputations: no additional assessment tool; determined by the percentage loss of limb/s or assessment of equivalent impairment
- Permanent blindness: no additional assessment tool; you must be legally blind in both eyes
What happens after you apply
We'll write to you to let you know the outcome of your application. If you're eligible, you'll be accepted as an 'interim participant' for two years.
During this time, we will pay for any ‘reasonable and necessary’ treatment, rehabilitation and care that you need as a result of your motor accident injury.
If you’re not eligible for the Scheme, you may still have your treatment, rehabilitation and care provided by local public health services or an insurer, if you have a Compulsory Third Party claim.
If you disagree with our decision about your eligibility, you can dispute the decision. A CTP insurer can also dispute our eligibility decision.
Applying for lifetime participation
If you were accepted into the Scheme two years ago and are nearing the end of your two-year interim period, you should submit an application for ‘lifetime participation’.
For further information, please speak with your coordinator or case manager and download our Applying for lifetime participation information sheet below.
Compulsory Third Party insurance
If you were injured in a motor accident that was caused by the fault of another driver, you may be eligible for compensation under the Compulsory Third Party (CTP) insurance scheme.
Completing an application for the Lifetime Care and Support Scheme, is not the same as completing a personal injury claim for CTP insurance.