How we care for people severely injured on the road

If you’ve been severely injured in a NSW motor accident, you may be eligible to become a lifetime care participant.

Eligibility for the Lifetime Care and Support Scheme

  1. You were injured in a motor accident in NSW
    On or after 1 October 2006 (for children under 16) or on or after 1 October 2007 (for adults)
  2. Your injury was caused by the motor accident
  3. The type and severity of your motor accident injury meet the injury criteria
    Each application is assessed against specific criteria outlined in the Lifetime Care and Support guidelines.

Each application is assessed against specific criteria outlined in the icare lifetime care guidelines.

As a no-fault scheme, it doesn’t matter who was at fault in the accident as long as you meet the eligibility criteria.

Severe injuries can include:

  • Traumatic brain injury
  • Spinal cord injury
  • Amputations
  • Burns
  • Permanent blindness

How we assess injuries

Whether you’re eligible for the Scheme is partly determined by the severity of your injury.

As part of the application process, your treating specialist will need to complete a medical certificate to confirm the severity of your injury. Your treating team may also need to complete a specific assessment for your type of injury to help determine if your injury will meet our eligibility criteria.

Below are the assessment tools we use for each type of injury that may be eligible for 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

    Eligibility for the Scheme

  • Brain injuries

    The Lifetime Care and Support Guidelines define a traumatic brain injury as an insult to the brain, usually with an associated diminished or altered state of consciousness that results in permanent impairments of cognitive, physical and/or psychosocial functions.

    You may be eligible for the Scheme if you've sustained a traumatic brain injury and:

    • The brain injury was caused by the motor accident; and
    • The duration of Post Traumatic Amnesia (PTA) is greater than 1 week. If the PTA assessment is not available or applicable (for example, if the child is under 8 years of age, or the injured person has a penetrating brain injury), there must be evidence of a very significant impact to the head, causing coma for longer than one hour, or a significant brain imaging abnormality due to the motor accident; and
    • One of the following criteria is met:
      • If over 8 years of age: a score of 5 or less on any of the items on the FIM™ or WeeFIM®) due to the brain injury; or
      • If aged from 3 to 8 years: a score two less than the age norm on any item on the WeeFIM® due to the brain injury; or
      • If aged under 3 years: a medical certificate from a paediatric rehabilitation physician or a specialist otherwise approved in writing by us that states the child will probably have permanent impairment due to the brain injury resulting in the need for daily attendant care services. 
  • Spinal cord injuries

    The Lifetime Care and Support Guidelines define spinal cord injury as an acute traumatic lesion of the neural elements in the spinal canal (spinal cord and cauda equina) resulting in permanent sensory deficit, motor deficit or bladder/bowel dysfunction.

    You may be eligible for the Scheme if you’ve sustained a spinal cord injury and if:

    • The spinal cord injury was caused by the motor accident; and
    • There is a spinal cord injury resulting in permanent neurological deficit.
  • Amputations

    You may be eligible for the scheme if you’ve had an amputation or amputations, or the equivalent impairment, as described below.

    Criteria for multiple amputations

    • The injury resulting in the amputations, or the equivalent impairment, was caused by the motor accident; and
    • You have multiple amputations of the upper and/or lower extremities, meaning that there is more than one of the following types of amputation at or above the level of:
      • a “short” transtibial or standard transtibial amputation, as defined by the loss of 50% or more of the length of the tibia. This includes all other amputations of the lower extremity (such as knee disarticulation or transfemoral amputation) above this level;
      • a thumb and index finger of the same hand, at or above the first metacarpophalangeal joint. This includes all other amputations of the upper extremity (such as below-elbow or above elbow amputation) above this level. 

    Criteria for unilateral amputation

    • The injury resulting in the amputation, or the equivalent impairment, was caused by the motor accident; and
    • You have one of the following types of amputation:
      • forequarter amputation (complete amputation of the humerus, scapula and clavicle) or shoulder disarticulation;
      • hindquarter amputation (hemipelvectomy by transection at sacroiliac joint, or partial pelvectomy);
      • hip disarticulation (complete amputation of the femur); or
      • “short” transfemoral amputation as defined by the loss of 65% or more of the length of the femur.

  • Burns

    You may be eligible for the Scheme if you have sustained burns and:

    • The burns were caused by the motor accident; and
    • You have full thickness burns greater than 40% of your total body surface area, or greater than 30% of your total body surface area if you are a child under 16 years; or
    • You have inhalation burns that have caused long term respiratory impairment; or
    • You have full thickness burns to the hand, face or genital area; and
    • One of the following criteria is met:
      • If you are over 8 years of age: a score of 5 or less on any of the items on the FIM™ or WeeFIM® due to the burns; or
      • If you are aged from 3 to 8: a score two less than the age norm on any item on the WeeFIM® due to the burns; or
      • If you are aged under 3 years: a medical certificate from a paediatrician or a specialist otherwise approved in writing by us that states the child will probably have permanent impairment due to the burns resulting in the need for daily attendant care services.
  • Permanent blindness

    You may be eligible for the Scheme if you’ve lost sight in both eyes and:

    • The loss of sight was caused by the motor accident; and
    • You are legally blind, defined by:
      • Visual acuity on the Snellen Scale after correction by suitable lenses is less than 6/60 in both eyes; or
      • Field of vision is constricted to 10 degrees or less of arc around central fixation in the better eye irrespective of corrected visual acuity (equivalent to 1/100 white test object); or
      • A combination of visual defects resulting in the same degree of visual loss as that occurring in either of the definitions above.