The NSW Lifetime Care & Support Scheme

PUBLISHED 02 Jul 2011
The Lifetime Care and Support Scheme provides lifelong no-fault benefits for those catastrophically injured in motor vehicle accidents.
 
The Lifetime Care and Support Scheme became operative for motor vehicle accidents involving children under the age of 16 from 1 October 2006 and became operative for adults from 1 October 2007.
 
Eligibility
 
There are three ways to become part of the scheme. Firstly, the injured person can elect to become a participant in the scheme, secondly the insurer can nominate an injured person for inclusion in the scheme and thirdly, the motor accidents authority can direct an insurer to nominate an injured person for inclusion in the scheme.
 
A person accepted as a lifetime participant in the scheme remains a participant for life.
 
All participants over the age of 3 years will be accepted as interim participants for 2 years, and an application can then be made for lifetime participation.
 
Injuries that qualify for the scheme
 
There are 5 categories of injuries that may qualify for the scheme, namely:
 
1.        Spinal cord injuries.
2.        Brain injuries.
3.        Multiple amputations.
4.        Burns.
5.        Permanent blindness.
 
The Benefits
 
The Lifetime Care and Support Authority will pay for scheme participants’ treatment and care. Treatment and are is defined to incorporate the following:
 
(a)      Medical treatment (including pharmaceuticals);
(b)      Dental treatment;
(c)       Rehabilitation;
(d)      Ambulance transportation;
(e)      Respite care;
(f)        Attendant care services;
(g)      Domestic assistance;
(h)      Aids and appliances;
(i)        Artificial members, eyes and teeth;
(j)        Education and vocational training;
(k)       Home and transport modification;
(l)        Workplace and educational facility modifications;
(m)     Such other kinds of treatment, care, support or services as may be prescribed by the regulations.
 
These categories are broad enough to cover hospital expenses and the cost of placement of claimant in a nursing home, group home or other institution.
 
Participants with a CTP Claim – Can they claim further?
 
In cases where an injured person becomes a participant in the scheme but can also establish fault, they will be able to make a CTP claim for those heads of damages not covered by the scheme including non-economic loss, past and future economic loss, heads of damages not covered by the scheme and heads of damages that are only partially covered by the scheme.
 
There is nothing in the Lifetime Care Support Scheme that affects the rights of those who can establish fault to recover general damages, loss of earnings or any other lump sum compensation that are not covered by the scheme.
 
A claimant who can establish fault cannot sue to recover lump sum compensation in relation to those benefits covered by the scheme, namely treatment and care benefits.
 
Disadvantages of the Lifetime Care Support Scheme
 
1.             Mandatory participation – effectively, this means that those who are eligible have no choice but to be part of the scheme, even if they can prove fault.
 
2.             Unpaid family assistance – this includes prohibition on recovering any Griffith v Kerkemeyer damages for voluntary domestic assistance. The reason for this is that the scheme will cover all care needs on a paid basis, so no voluntary domestic assistance should be required.
 
3.             Legal representation – the Lifetime Care and Support Scheme has been set up to minimise involvement of insurers and lawyers. There is no recovery of legal fees in relation to a medical dispute over illegibility or for a dispute about treatment needs.
 
4.             No funding for capital costs of accommodation, transport and computers – the scheme makes no provision for funding the capital costs involved in purchasing a suitable house, car or computer equipment. There is only provision to modify existing property. The scheme also does not cover increased cost of rent. Those however, who can prove fault should be able to claim the capital cost as part of their CTP claim.
 
Buying into the Lifetime Care and Support Scheme
 
People who were injured in motor vehicle accidents before the commencement of the Lifetime Care Support Scheme, and who meet the eligibility for the scheme, can buy in to become a lifetime participant of the scheme.
 
Once a participant buys into the scheme they will have the same obligations and entitlement as any other participant in the scheme, namely, full lifetime cost of reasonable and necessary treatment, rehabilitation and care needs. 
 
The cost of buying in will have to be paid to the Lifetime Care Support Authority upfront. This provision is designed to be utilised by people who have been injured prior to the introduction of the lifetime care support scheme and have received a lump sum payment for the future treatment and care needs.
 
Conclusion
 
The Lifetime Care Support Scheme provides previously unattainable benefits to those that are at fault and those who have contributed heavily to their own injury. For those who can establish fault the Lifetime Care Support Scheme does provide the benefit of certainty that their care and treatment needs will always be met.

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