Motor Accidents (Lifetime Care and Support) Act 2006
In ForceNSW
Jurisdiction
New South Wales
Act Number
16 of 2006
Collection
act
Plain English Summary
7/10 complexity
Creates the Lifetime Care and Support Authority and a dedicated Fund to provide lifetime (or interim) treatment and care for people seriously injured in motor accidents. The Authority assesses needs, pays reasonable necessary services (subject to eligibility, approved providers, fee controls and LTCS Guidelines) and is financed mainly by a proportion of third‑party motor insurance levies set using independent actuarial reports. It affects injured people, approved providers and insurers, includes panel-based dispute resolution, and can recover costs from uninsured or at‑fault parties.
The Motor Accidents (Lifetime Care and Support) Act 2006 (the Act) establishes a no-fault statutory scheme that meets the assessed treatment and care needs of persons who sustain catastrophic motor accident injuries. At its core, the legislation shifts the financial burden of lifelong care from injured individuals (or their damages claims) to a dedicated fund financed by compulsory third-party motor vehicle insurance levies.
Section 3 defines the Scheme as “the scheme provided for by this Act for the lifetime care and support of persons injured in motor accidents”. Participation is available on either a lifetime or interim basis (s 7(2)). Lifetime participants remain in the Scheme for life (s 9(4)); interim participants remain for a defined period—two years if aged three or over at acceptance, or until age five if accepted under three (ss 9(5)–(5A)). An interim participant must be upgraded to lifetime status once the Authority is satisfied they meet the lifetime criteria (s 9(3)).
The Authority’s central obligation is contained in s 11A(1): it “is to pay for all of the reasonable expenses incurred by or on behalf of a person in relation to the assessed treatment and care needs of the person while the person is a participant”. “Treatment and care needs” are exhaustively listed in s 5A(1) and include medical treatment (including pharmaceuticals), dental treatment, rehabilitation, ambulance transportation, respite care, attendant care services, aids and appliances, prostheses, education and vocational training, home and transport modification, workplace and educational facility modifications, and any other kinds prescribed by regulation. Excluded needs are declared by regulation (s 5A(2)).
Assessments of what is “reasonable and necessary in the circumstances” and causally related to the motor accident injury are performed by the Authority in accordance with the LTCS Guidelines (s 23(3)). Participants may dispute the Authority’s assessment; the dispute is referred to an assessor (s 24) whose decision may itself be reviewed by a Review Panel on limited grounds (s 25). Both the Authority’s original assessment and any assessor or Review Panel determination are final and binding (ss 16, 26(1)).
Current sections
Direct links to the current provisions in Motor Accidents (Lifetime Care and Support) Act 2006.
(1) This Act commences on a day or days to be appointed by proclamation, except as provided by subsection (2).
(2) Section 66 (Auditor-General to report on Costing Study) commences on the date of assent to this Act.
3
Definitions
3 Definitions
3 Definitions
(1) In this Act—
approved provider—see section 11C (2).
assessed treatment and care needs—see section 11A (2).
attendant care services means services that aim to provide assistance to people with everyday tasks, and includes (for example) personal assistance, nursing, home maintenance and domestic services.
Authority means the Lifetime Care and Support Authority of New South Wales constituted by this Act.
chief executive means the chief executive of the Authority appointed under this Act.
excluded treatment and care needs—see section 5A (2).
Fund means the Lifetime Care and Support Authority Fund established by this Act.
insurer of a claim means an insurer for the purposes of Chapter 4 (Motor accident claims) of the Motor Accidents Compensation Act 1999 in relation to the claim.
LTCS Guidelines means guidelines issued by the Authority under section 58, as in force from time to time.
motor accident injury means injury caused by a motor accident.
Note.
Section 4 provides for the motor accident injuries to which this Act applies.
participant in the Scheme means a person accepted as provided by this Act as a participant in the Scheme (either as a lifetime participant or as an interim participant).
relevant Scheme commencement date, with respect to a person who has suffered motor accident injuries, means—
(a) 1 October 2006 if the person was under 16 years of age at the time of the motor accident that caused the injuries, or
(b) 1 October 2007 in any other case.
the Scheme means the scheme provided for by this Act for the lifetime care and support of persons injured in motor accidents.
treatment and care needs—see section 5A.
treatment and care needs assessment means an assessment under Part 4 of the treatment and care needs of a participant in respect of the participant’s motor accident injury.
Note.
The Interpretation Act 1987 contains definitions and other provisions that affect the interpretation and application of this Act.
(2) Notes included in this Act do not form part of this Act.
s 3: Am 2009 No 33, Sch 1 [1]; 2009 No 96, Sch 14 [1]; 2012 No 48, Sch 1 [1] [2]; 2012 No 54, Sch 3.2 [1]–[3]; 2015 No 19, Sch 8 [1] [2].
4
Application of Act
4 Application of Act
4 Application of Act
(1) This Act applies only in respect of motor accident injuries suffered by a person as a result of a motor accident occurring on or after the relevant Scheme commencement date.
Note.
Section 7A provides for a limited exception to this provision.
(2) This Act applies only in respect of motor accident injuries resulting from motor accidents occurring in New South Wales.
Note.
Section 7B provides for a limited exception to this provision.
(3) This Act applies in respect of a motor accident injury only if there is a motor vehicle involved in the motor accident concerned that has motor accident insurance cover for the motor accident (within the meaning of section 3B of the Motor Accidents Compensation Act 1999), whether or not all the motor vehicles involved in the motor accident have motor accident insurance cover for the motor accident.
(4) This Act applies in respect of a motor accident injury whether or not the injury was caused by the fault of the owner or driver of the motor vehicle in the use or operation of the vehicle or of any other person and so applies even if the injured person was at fault (whether as owner or driver of the vehicle or otherwise).
(5) The regulations may make provision (including provision of a savings or transitional nature) for or with respect to limiting the application of this Act or any specified provisions of this Act to specified classes of persons.
s 4: Am 2009 No 33, Sch 1 [2]; 2017 No 10, Sch 5.10 [1].
(1) For the purposes of this Act, the treatment and care needs of a participant in the Scheme are the participant’s needs for or in connection with any of the following—
(a) medical treatment (including pharmaceuticals),
(b) dental treatment,
(c) rehabilitation,
(d) ambulance transportation,
(e) respite care,
(f) attendant care services,
(g) aids and appliances,
(h) prostheses,
(i) education and vocational training,
(j) home and transport modification,
(k) workplace and educational facility modifications,
(l) such other kinds of treatment, care, support or services as may be prescribed by the regulations under this paragraph.
(2) Despite subsection (1), the treatment and care needs of a participant do not include any treatment, care, support or services of a kind declared by the regulations to be excluded treatment and care needs.
s 5A: Ins 2012 No 48, Sch 1 [3].
Part 2
Participation in Scheme
Part 2 Participation in Scheme
Part 2 Participation in Scheme
pt 2, hdg: Subst 2012 No 48, Sch 1 [4].
6
6
6 (Repealed)
7
Eligibility for participation in the Scheme
7 Eligibility for participation in the Scheme
7 Eligibility for participation in the Scheme
(1) A person who has suffered a motor accident injury is eligible to be a participant in the Scheme in respect of the injury if the person’s injury satisfies the criteria specified in the LTCS Guidelines for eligibility for participation in the Scheme.
(2) Participation in the Scheme may be as a lifetime participant or an interim participant and for that purpose the LTCS Guidelines are to establish criteria for eligibility for lifetime participation and criteria for eligibility for interim participation in the Scheme.
(3) A person is not eligible to be a participant in the Scheme in relation to an injury if the person has been awarded damages, pursuant to a final judgment entered by a court or a binding settlement, for future economic loss in respect of the treatment and care needs of the participant that relate to the injury.
(4) The LTCS Guidelines may make provision for or with respect to eligibility for participation in the Scheme, including provision for or with respect to the criteria that a motor accident injury must satisfy for the injured person to be eligible for participation in the Scheme in respect of the injury and the determination of whether a motor accident injury satisfies those criteria.
7A
Persons injured before commencement of Scheme may “buy in”
7A Persons injured before commencement of Scheme may “buy in”
7A Persons injured before commencement of Scheme may “buy in”
(1) A person who has suffered a motor accident injury as a result of a motor accident occurring before the relevant Scheme commencement date (a pre-commencement injury) may be accepted as a lifetime participant in the Scheme if the person pays to the Authority, for payment into the Fund, a contribution determined by the Authority.
(2) The contribution is to be the amount that the Authority determines as the amount required to fund the treatment and care needs of the person as a lifetime participant in the Scheme in respect of the injury.
(3) A person is eligible to participate in the Scheme in respect of a pre-commencement injury only if the person would have been eligible to participate in the Scheme—
(a) had the motor accident occurred immediately after the relevant Scheme commencement date, and
(b) if the person has been awarded damages in respect of the injury—had those damages not been awarded.
(4) An application for a person to become a participant in the Scheme in respect of a pre-commencement injury cannot be made by an insurer.
(5) The LTCS Guidelines may make provision for or with respect to how a person’s contribution for participation in the Scheme in respect of a pre-commencement injury is to be determined.
s 7A: Ins 2009 No 33, Sch 1 [3].
7B
Persons injured in motor accidents occurring outside NSW may “buy in”
7B Persons injured in motor accidents occurring outside NSW may “buy in”
7B Persons injured in motor accidents occurring outside NSW may “buy in”
(1) A person who has suffered a motor accident injury as a result of a motor accident occurring outside New South Wales (whether before or after the commencement of this section) may be accepted as a lifetime participant in the Scheme if the person pays to the Authority, for payment into the Fund, a contribution determined by the Authority.
(2) The contribution is to be the amount that the Authority determines as the amount required to fund the treatment and care needs of the person as a lifetime participant in the Scheme in respect of the injury.
(3) A person is eligible to participate in the Scheme under this section only if the person would have been eligible to participate in the Scheme—
(a) had the motor accident occurred in New South Wales, and
(b) if the person has been awarded damages in respect of the injury—had those damages not been awarded.
(4) An application for a person to become a participant in the Scheme under this section cannot be made by an insurer.
(5) The LTCS Guidelines may make provision for or with respect to how a person’s contribution for participation in the Scheme under this section is to be determined.
s 7B: Ins 2017 No 10, Sch 5.10 [2].
8
Application for participation in the Scheme
8 Application for participation in the Scheme
8 Application for participation in the Scheme
(1) An application for a person to become a participant in the Scheme in respect of a motor accident injury is to be made to the Authority and can only be made by or on behalf of the person or by the insurer of a claim made by the person in respect of the injury.
(2) An application by an insurer does not require the consent of the person.
(3) The State Insurance Regulatory Authority may direct the insurer of a claim made by a person in respect of an injury to make an application for the person to become a participant in the Scheme, and the insurer must comply with such a direction.
(4) An application is to be made in the form approved by the Authority and is to set out or be accompanied by such particulars and information as may be required by the approved form.
(5) The Authority may require the injured person to provide authorisation for the Authority to obtain information and documents relevant to the motor accident injury from specified persons in connection with the application.
(6) The LTCS Guidelines may make provision for or with respect to applications to become a participant in the Scheme, including provision for or with respect to—
(a) the making and determination of applications (including the information required to be provided in connection with an application), and
(b) requiring an insurer to pay the costs of any assessment required by the LTCS Guidelines in connection with an application, and
(c) imposing restrictions on the time within which an application can be made or requiring the deferring of the making of an application until an injury has stabilised.
s 8: Am 2015 No 19, Sch 8 [3].
9
Acceptance as a participant
9 Acceptance as a participant
9 Acceptance as a participant
(1) A person becomes a participant in the Scheme if the Authority is satisfied that the person is eligible to be a participant and accepts the person in writing as a participant in the Scheme, either as a lifetime participant or an interim participant (according to the person’s eligibility).
(2) If the Authority is satisfied that a person is eligible to be a participant and that application for the person’s acceptance as a participant has been duly made, the Authority must accept the person as a lifetime participant or an interim participant (according to the person’s eligibility).
(3) A person accepted as an interim participant must be accepted as a lifetime participant if the Authority becomes satisfied during the person’s interim participation in the Scheme that the person is eligible for lifetime participation in the Scheme.
(4) A person accepted as a lifetime participant in the Scheme remains a participant for life.
(5) A person 3 years of age or over who is accepted as an interim participant remains an interim participant for a period of 2 years only.
(5A) A person under 3 years of age who is accepted as an interim participant remains an interim participant until the person is 5 years of age.
(5B) If a person who is an interim participant is accepted as a lifetime participant, the person ceases to be an interim participant on that acceptance and then remains a participant for life.
(6) A person cannot be accepted as an interim participant more than once in relation to the same motor accident injury.
(7) The expiration of a period of interim participation in the Scheme does not prevent subsequent acceptance of the person as a lifetime participant in the Scheme.
s 9: Am 2009 No 33, Sch 1 [4].
10
10
10 (Repealed)
11
Effect of Scheme on motor accident compensation claims and limitation periods
11 Effect of Scheme on motor accident compensation claims and limitation periods
11 Effect of Scheme on motor accident compensation claims and limitation periods
(1) This Act does not limit or otherwise affect the application of the Motor Accidents Compensation Act 1999 in respect of a motor accident injury of a person who is or who is eligible to become a participant in the Scheme, except as specifically provided by that Act.
(2) While a person is an interim participant in the Scheme in respect of an injury, time does not run for the purposes of section 109 (Time limitations on commencement of court proceedings) of the Motor Accidents Compensation Act 1999 or a provision of the Limitation Act 1969 in respect of a cause of action on a claim for damages that relate to the injury or to any other injury suffered by the person as a result of the motor accident concerned.
Part 2A
Payments under Scheme
Part 2A Payments under Scheme
Part 2A Payments under Scheme
pt 2A: Ins 2012 No 48, Sch 1 [6].
11A
Assessed treatment and care needs of participants to be paid for by Authority
11A Assessed treatment and care needs of participants to be paid for by Authority
11A Assessed treatment and care needs of participants to be paid for by Authority
(1) The Authority is to pay for all of the reasonable expenses incurred by or on behalf of a person in relation to the assessed treatment and care needs of the person while the person is a participant in the Scheme.
(2) The assessed treatment and care needs of a person who is a participant in the Scheme are those treatment and care needs that are assessed by the Authority, in its treatment and care needs assessment, to be treatment and care needs that—
(a) are reasonable and necessary in the circumstances, and
(b) relate to the motor accident injury in respect of which the person is a participant.
(3) No expenses are payable in respect of—
(a) excluded treatment and care needs, and
(b) treatment and care needs that are not assessed treatment and care needs.
(4) As an alternative to paying the expenses for which it is liable under this section as and when they are incurred, the Authority may pay those expenses by the payment to the participant of an amount to cover those expenses over a fixed period pursuant to an agreement between the Authority and the participant for the payment of those expenses by the participant.
(5) The LTCS Guidelines may make provision for or with respect to determining which treatment and care needs of a participant in the Scheme are reasonable and necessary in the circumstances and relate to the motor accident injury in respect of which the person is a participant.
s 11A: Ins 2012 No 48, Sch 1 [6].
11AA
Option of contribution to other cost effective expenditure for meeting treatment and care needs
11AA Option of contribution to other cost effective expenditure for meeting treatment and care needs
11AA Option of contribution to other cost effective expenditure for meeting treatment and care needs
(1) The Authority has the option of satisfying its liability under this Part to pay for expenses incurred in relation to a participant’s assessed treatment and care needs by contributing to alternative expenditure (incurred by or on behalf of the participant) that the Authority is satisfied will provide for those needs in a cost effective manner.
(2) The Authority’s contribution to alternative expenditure is limited to the amount of a reasonable contribution to that expenditure and is not to exceed the amount for which the Authority would otherwise have been liable under this Part to pay for expenses incurred in relation to a participant’s assessed treatment and care needs.
(3) An assessment of the option of contributing to alternative expenditure under this section is part of the assessment of the treatment and care needs of a participant in the Scheme.
Note.
Because an assessment of this option is part of the assessment of the treatment and care needs of a participant, Part 4 and the LTCS Guidelines extend to an assessment of that option.
s 11AA: Ins 2014 No 77, Sch 1 [1].
11B
Payment not required in certain circumstances
11B Payment not required in certain circumstances
11B Payment not required in certain circumstances
(1) The Authority is not required to make a payment in relation to the following—
(a) any treatment, care, support or service provided to a participant in the Scheme on a gratuitous basis (that is, anything provided to a participant for which the participant has not paid and is not liable to pay),
(b) any treatment, care, support or service that is required to be provided by an approved provider but is provided by a person who is not, at the time of the provision, an approved provider.
(2) However, the Authority may elect to make a payment in relation to any treatment, care, support or service referred to in subsection (1) if the Authority is of the opinion that special circumstances exist that justify such payment.
(3) The LTCS Guidelines may make provision for or with respect to determining whether special circumstances exist that justify payment in relation to any treatment, care, support or service referred to in subsection (1).
(4) To avoid doubt, this section applies even if the treatment, care, support or services concerned are provided in connection with the provision of the assessed treatment and care needs of a participant in the Scheme.
(5) This section has effect despite section 11A.
s 11B: Ins 2012 No 48, Sch 1 [6].
11C
Approved providers
11C Approved providers
11C Approved providers
(1) The following treatment, care, support or services (provided in connection with the provision of assessed treatment and care needs of a participant in the Scheme) are to be provided only by an approved provider of the treatment, care, support or service—
(a) attendant care services,
(b) any other treatment, care, support or services (other than the services of a medical practitioner) identified in the LTCS Guidelines as treatment, care, support or services that are to be provided by an approved provider.
(2) An approved provider of a service is a person, or a person of a class, approved by the Authority (or by any other person specified in the LTCS Guidelines), in accordance with the LTCS Guidelines, to provide the treatment, care, support or service under the Scheme.
(3) The LTCS Guidelines may also make provision for or with respect to the standards of competency of approved providers.
s 11C: Ins 2012 No 48, Sch 1 [6].
Part 3
Dispute resolution
Part 3 Dispute resolution
Part 3 Dispute resolution
Division 1
Disputes about eligibility
Division 1 Disputes about eligibility
Division 1 Disputes about eligibility
12
Definitions
12 Definitions
12 Definitions
In this Division—
Assessment Panel means a panel of assessors convened under this Division to determine a dispute under this Division.
assessor means a person appointed under this Division as an assessor for the purposes of this Division.
Review Panel means a panel of assessors convened under this Division to review a determination by an Assessment Panel.
13
Appointment of assessors
13 Appointment of assessors
13 Appointment of assessors
The Authority is to appoint medical practitioners and other suitably qualified persons to be assessors for the purposes of this Division.
14
Referral of disputes to Assessment Panel
14 Referral of disputes to Assessment Panel
14 Referral of disputes to Assessment Panel
(1) If there is a dispute as to whether a motor accident injury suffered by a person satisfies criteria specified in the LTCS Guidelines for eligibility for participation in the Scheme, the dispute can be referred to an Assessment Panel for determination.
(2) The dispute can be referred by the Authority or by notice to the Authority given by or on behalf of the injured person or by the insurer of the injured person’s claim.
(3) The Authority is to convene a panel of 3 assessors to constitute the Assessment Panel to determine a dispute referred under this section.
(4) The Assessment Panel to which a dispute is referred for determination is to determine the dispute and is to give a certificate as to its determination setting out the reasons for its determination.
15
Review of Assessment Panel’s determination
15 Review of Assessment Panel’s determination
15 Review of Assessment Panel’s determination
(1) The determination of an Assessment Panel can be referred for review by a Review Panel, but only on one or more of the following grounds—
(a) a change in the condition of the injured person, being a change that occurred or that first became apparent after the dispute was referred for determination by the Assessment Panel and that is capable of having a material effect on the determination,
(b) the availability of additional relevant information about the injury, being information that was not available, or could not reasonably have been obtained, before the dispute was referred for determination by the Assessment Panel and that is capable of having a material effect on the determination,
(c) the determination was not made in accordance with the LTCS Guidelines,
(d) the determination is demonstrably incorrect in a material respect.
(2) A determination can be referred for review—
(a) by or on behalf of the injured person, or
(b) by the insurer of the injured person’s claim, or
(c) by the Authority.
(3) The Authority is to convene a panel of 3 assessors to constitute the Review Panel to review the determination of the Assessment Panel.
(4) The Review Panel can confirm the determination of the Assessment Panel or it can revoke that determination, substituting its own determination and giving a certificate as to its determination.
16
Determinations to be binding
16 Determinations to be binding
16 Determinations to be binding
The determination of an Assessment Panel (or of a Review Panel on the review of an Assessment Panel’s determination) as to whether a motor accident injury satisfies criteria specified in the LTCS Guidelines for eligibility for participation in the Scheme is final and binding for the purposes of this Act and any proceedings under this Act.
17
Costs of assessment
17 Costs of assessment
17 Costs of assessment
(1) The costs of determinations and reviews of determinations under this Division are payable by the Authority.
(2) The costs of determinations and reviews under this Division include the necessary costs and expenses of travel and accommodation incurred by the injured person, and by a parent or other carer of the injured person in order to accompany the injured person, in attending a panel for the purposes of the determination or review.
18
No legal costs payable by Authority
18 No legal costs payable by Authority
18 No legal costs payable by Authority
(1) No legal costs are payable by the Authority for or in respect of legal services provided to an injured person or an insurer in connection with the referral of a matter for or the making of a determination or review of a determination under this Division.
(1) Determinations and reviews under this Division are subject to relevant provisions of the LTCS Guidelines relating to the procedures for the referral of disputes for determination or review of determinations and the procedure for determination.
(2) The Authority may arrange for the provision of training and information to assessors to promote accurate and consistent determinations and reviews under this Division.
Division 2
Disputes about motor accident injury
Division 2 Disputes about motor accident injury
Division 2 Disputes about motor accident injury
20
Determination of disputes
20 Determination of disputes
20 Determination of disputes
(1) An interested person who disputes a decision of the Authority as to whether an injury is a motor accident injury may request the Authority to refer the dispute for determination under this section.
(2) Each of the following is an interested person—
(a) the person whose injury is the subject of the Authority’s decision,
(b) the insurer of a claim made by the injured person in respect of the injury,
(c) the Nominal Defendant.
(3) The Authority is to refer the dispute to the President for the determination of the Commission under Part 4.4 of the Motor Accidents Compensation Act 1999.
Note.
Part 4 of Schedule 4 to the Personal Injury Commission Act 2020 requires the Commission to be constituted by 3 general members of the Commission assigned to the Motor Accidents Division of the Commission.
(4) The Commission is to determine the dispute and certify in writing as to its determination giving reasons for its determination.
(5) The Commission’s determination as to whether an injury is a motor accident injury is final and binding for the purposes of this Act and any proceedings under this Act.
s 20: Am 2020 No 18, Sch 6.8[1] [2].
21
Legal costs
21 Legal costs
21 Legal costs
(1) The Commission determining a dispute under this Division is to include in its determination a determination of the amount of the reasonable legal costs payable by the injured person for or in respect of legal services provided to the person in connection with the referral for determination of and the determination of the dispute.
(2) The Authority is to pay those reasonable legal costs of the injured person as assessed by the Commission. No other legal costs are payable by the Authority for or in respect of legal services provided to an interested person in connection with the referral for determination of and the determination of a dispute under this Division.
(3) The regulations may make provision for or with respect to fixing maximum legal costs for legal services provided to a person in connection with the referral for determination of and the determination of a dispute under this Division.
(4) A legal practitioner is not entitled to be paid or recover for a legal service an amount that exceeds any maximum legal costs fixed for the service by the regulations under this section.
(5) This section does not entitle a legal practitioner to recover legal costs for a legal service or matter that a court or costs assessor determines were unreasonably incurred.
(6) This section and any regulations under this section prevail to the extent of any inconsistency with the legal costs legislation (as defined in section 3A of the Legal Profession Uniform Law Application Act 2014). An assessment under that legislation of any costs in respect of which provision is made by a regulation under this section is to be made so as to give effect to that regulation.
s 21: Am 2015 No 7, Sch 2.31 [2] [3]; 2020 No 18, Sch 6.8[2].
Part 4
Treatment and care needs assessment
Part 4 Treatment and care needs assessment
Part 4 Treatment and care needs assessment
22
Definitions
22 Definitions
22 Definitions
In this Part—
assessor means a person appointed under this Part to make an assessment in relation to a disputed assessment under this Part.
Review Panel means a panel of assessors convened under this Part to review an assessment under this Part.
23
Assessment of treatment and care needs of participants
23 Assessment of treatment and care needs of participants
23 Assessment of treatment and care needs of participants
(1) The Authority is to make an assessment of the treatment and care needs of a participant in the Scheme.
(2) The assessment is an assessment of the participant’s treatment and care needs that are reasonable and necessary in the circumstances, and as relate to the motor accident injury in respect of which the person is a participant in the Scheme.
(3) An assessment of treatment and care needs is to be made in accordance with the LTCS Guidelines.
(4) The Authority is to certify in writing as to its assessment of the treatment and care needs of the participant including its reasons for any finding on which the assessment is based, and is to give a copy of the certificate to the participant.
24
Dispute about Authority’s assessment—determination by assessor
24 Dispute about Authority’s assessment—determination by assessor
24 Dispute about Authority’s assessment—determination by assessor
(1) If a participant in the Scheme disputes an assessment or any aspect of an assessment by the Authority of the treatment and care needs of the participant, the Authority must, at the request of the participant, refer the dispute to an assessor for determination.
(2) A participant cannot make such a request more than 28 days after the Authority gives the participant a copy of the Authority’s certificate of assessment of the treatment and care needs of the participant.
(3) The Authority is to appoint health professionals and other suitably qualified persons to be assessors for the purposes of this Part.
(4) The assessor who determines a dispute about the treatment and care needs of a participant is to give a certificate to the Authority and the participant certifying as to the assessor’s determination and setting out the assessor’s reasons for any finding on which the determination is based.
25
Review of assessor’s determination
25 Review of assessor’s determination
25 Review of assessor’s determination
(1) The Authority or a participant can refer an assessor’s determination of a dispute about the treatment and care needs of the participant for review by a Review Panel, but only on one or more of the following grounds—
(a) the availability of additional relevant information about the treatment and care needs of the participant, being information that was not available, or could not reasonably have been obtained, at the time of the assessor’s determination and that is capable of having a material effect on the determination,
(b) the assessor’s determination was not made in accordance with the LTCS Guidelines,
(c) the assessor’s determination is demonstrably incorrect in a material respect.
(2) An assessor’s determination can be referred for review not later than 28 days after the assessor’s certificate of determination is given to the Authority and the participant.
(3) The Authority is to convene a panel of 3 assessors to constitute the Review Panel for the review of an assessor’s determination.
(4) On its review, the Review Panel can confirm the assessor’s determination or can revoke the assessor’s determination and substitute its own determination, giving the Authority and the participant a certificate of the determination and setting out the Review Panel’s reasons for any finding on which its determination is based.
(5) In conducting its review, a Review Panel must take into account any written submissions prepared by or on behalf of the participant that are submitted to the Panel.
26
Effect of assessment
26 Effect of assessment
26 Effect of assessment
(1) The Authority’s assessment of the treatment and care needs of a participant is final and binding for the purposes of this Act and any proceedings under this Act.
(2) The Authority is to revise its assessment to make any changes that may be necessary to give effect to any determination by an assessor or Review Panel of a dispute about those treatment and care needs.
(3) The Authority’s assessment of the treatment and care needs of a participant supersedes any earlier assessment by the Authority of those needs.
27
Co-operation of participant
27 Co-operation of participant
27 Co-operation of participant
A participant in the Scheme must comply with any reasonable request made by the Authority or an assessor in connection with an assessment of or dispute about the treatment and care needs of the participant, including a request to undergo a medical examination or other examination by a health professional.
28
LTCS Guidelines
28 LTCS Guidelines
28 LTCS Guidelines
(1) The LTCS Guidelines may make provision for or with respect to the assessment of the treatment and care needs of a participant in the Scheme.
(2) In particular, the LTCS Guidelines may make provision for or with respect to the following—
(a) the procedures to be followed in connection with such an assessment,
(b) the intervals at which such assessments are to be carried out,
(c) the methods and criteria to be used to determine the treatment and care needs of participants,
(d) the information to be provided by participants for the purposes of or in connection with assessments.
(3) An assessment of the treatment and care needs of a participant in the Scheme is to be carried out in accordance with the LTCS Guidelines.
29
No legal costs payable for assessment or review
29 No legal costs payable for assessment or review
29 No legal costs payable for assessment or review
(1) No legal costs are payable by the Authority for or in respect of legal services provided to a participant in the Scheme in connection with an assessment under this Part of the treatment and care needs of the participant or the determination or review of a determination under this Part of a dispute about such an assessment.
Bulk billing arrangements for hospital, ambulance and other expenses
30 Bulk billing arrangements for hospital, ambulance and other expenses
30 Bulk billing arrangements for hospital, ambulance and other expenses
(1) Bulk billing arrangements may be entered into by the Authority with respect to—
(a) the payment of expenses incurred in connection with the treatment of participants in the Scheme at hospitals, or
(b) the payment of expenses incurred in transporting participants in the Scheme by ambulance, or
(c) the payment of other treatment expenses incurred by participants in the Scheme.
(2) A bulk billing arrangement is an arrangement made with the Minister for Health, the State Insurance Regulatory Authority, service providers or others acting on their behalf for the payment by the Authority of any such expenses of participants in the Scheme at the rate provided by the arrangement.
(3) For the purposes of this section, the treatment or transport of participants in the Scheme includes the treatment or transport of persons classified as participants in the Scheme in accordance with a bulk billing arrangement.
s 30: Am 2015 No 19, Sch 8 [3].
31
Payment of hospital, ambulance, medical and other expenses not covered by bulk billing arrangement
31 Payment of hospital, ambulance, medical and other expenses not covered by bulk billing arrangement
31 Payment of hospital, ambulance, medical and other expenses not covered by bulk billing arrangement
(1) This section applies to—
(a) payment for the treatment of participants in the Scheme at hospitals, and
(b) payment for conveying participants in the Scheme by ambulance, and
(c) payment for any medical or dental treatment of, or rehabilitation services provided to, participants in the Scheme,
in any case where payment for the expenses concerned has not been made, and is not required to be made in accordance with a bulk billing arrangement under this Part.
(2) The rate at which such a payment is required to be made by the Authority under this Act is as follows—
(a) in the case of treatment at public hospitals—at the rate determined by the Minister for Health by order published in the Gazette,
(b) in any case in which a maximum rate is fixed under section 32—at the maximum rate so fixed,
(c) in a case to which a rate referred to in paragraph (a) or (b) does not apply—at the rate reasonably appropriate to the treatment or service having regard to the customary charge made in the community for the treatment or service.
(3) If the Authority does not make that payment, the body or person who provided the treatment or service to which the payment relates may recover the payment from the Authority as a debt in a court of competent jurisdiction.
32
Maximum fees payable for medical treatment and other treatment or services not provided at hospitals or for treatment at private hospitals
32 Maximum fees payable for medical treatment and other treatment or services not provided at hospitals or for treatment at private hospitals
32 Maximum fees payable for medical treatment and other treatment or services not provided at hospitals or for treatment at private hospitals
(1) This section applies to—
(a) the fee payable for any medical treatment of a participant in the Scheme, and
(b) the fee payable for any dental treatment of a participant in the Scheme, and
(c) the fee payable for any rehabilitation service provided to a participant in the Scheme, and
(d) the fees payable for any attendant care services provided to a participant in the Scheme,
but does not apply to any such treatment or service that is provided at a hospital (whether to an in-patient or out-patient) and for which any payment is required to be made to the hospital and not to the treatment or service provider.
(2) This section also applies to the fee payable to a private hospital for any treatment at the hospital.
(3) The regulations may make provision for or with respect to fixing the maximum amount for which the Authority is liable in respect of any claim for fees to which this section applies.
(4) Any such fees may (but need not) be fixed by reference to fees recommended by the Australian Medical Association or other professional association or by reference to any schedule of fees.
(5) A payment by the Authority in respect of a service provided in connection with the treatment and care needs of a participant in the Scheme is to be made consistently with any regulations under this section.
(6) This section does not prevent the inclusion in the LTCS Guidelines of provision as to the appropriate allowance for fees to which this section applies and that are not fixed by regulations under this section.
Part 6
Administration
Part 6 Administration
Part 6 Administration
33
Constitution of Authority
33 Constitution of Authority
33 Constitution of Authority
(1) There is constituted by this Act a corporation with the corporate name of the Lifetime Care and Support Authority of New South Wales.
(2) The Authority is, for the purposes of any Act, a statutory body representing the Crown.
34
34
34–36 (Repealed)
37
Financial year
37 Financial year
37 Financial year
(1) The financial year of the Authority is the year commencing on 1 July.
(2) However, the financial year of the Authority is to be the annual reporting period (if any) for the Authority if the Treasurer has made a determination under section 2.10 of the Government Sector Finance Act 2018 for that period to be different from the period referred to in subsection (1).
s 37: Am 2018 No 70, Sch 4.68.
38
Ministerial directions
38 Ministerial directions
38 Ministerial directions
(1) If the Minister is satisfied that it is desirable in the public interest to do so, the Minister may, by notice in writing to the Authority, give directions with respect to the functions of the Authority.
(2) The Minister cannot give a direction under this section with respect to the Authority’s functions under section 49.
(3) The Authority must comply with any direction given under this section by the Minister.
(4) The Authority must include in its annual report particulars of each direction given under this section during the year to which the report relates.
(5) Except as provided by this section, the Authority is not, in the exercise of its functions, subject to the control and direction of the Minister.
s 38: Am 2012 No 54, Sch 3.2 [5]–[8]. Subst 2015 No 19, Sch 8 [4]. Am 2017 No 10, Sch 5.10 [3].
39
Chief executive of Authority
39 Chief executive of Authority
39 Chief executive of Authority
(1) The Minister is to appoint a person as the chief executive of the Authority.
Note.
Schedule 1 contains provisions relating to the chief executive of the Authority.
(2) The affairs of the Authority are to be managed and controlled by the chief executive.
(3) Any act, matter or thing done in the name of, or on behalf of, the Authority by the chief executive is taken to have been done by the Authority.
s 39: Rep 2012 No 54, Sch 3.2 [4]. Ins 2015 No 19, Sch 8 [5].
40
40
40 (Repealed)
41
Delegation of functions
41 Delegation of functions
41 Delegation of functions
(1) The Authority may delegate to an authorised person any of the functions of the Authority (other than this power of delegation), including any function provided for by a care and support arrangement under section 43A.
(2) In this section—
authorised person means any of the following—
(a) a member of staff of Insurance and Care NSW,
(b) any person, or any class of persons, authorised for the purposes of this section by the regulations.
(3) (Repealed)
s 41: Am 2009 No 96, Sch 14 [4]; 2012 No 54, Sch 3.2 [9]; 2014 No 77, Sch 1 [2]; 2015 No 19, Sch 8 [6].
42
Seal of Authority
42 Seal of Authority
42 Seal of Authority
The seal of the Authority is to be kept by the chief executive and may be affixed to a document only—
(a) in the presence of the chief executive or a member of staff of the Authority who is authorised for the purpose by the chief executive, and
(b) with an attestation by the signature of the chief executive or that member of staff of the fact of the affixing of the seal.
s 42: Am 2009 No 96, Sch 14 [4] [5]; 2012 No 54, Sch 3.2 [10] [11]; 2015 No 19, Sch 8 [7].
Division 3
Functions of Authority
Division 3 Functions of Authority
Division 3 Functions of Authority
43
Functions of Authority
43 Functions of Authority
43 Functions of Authority
(1) The Authority has such functions as are conferred or imposed on it by or under this or any other Act.
(2) The Authority also has the following functions—
(a) to monitor the operation of the Scheme under this Act, and in particular to conduct (or arrange for other persons to conduct) research into and to collect statistics in relation to the operation of the Scheme,
(b) to advise the Minister as to the administration, efficiency and effectiveness of the Scheme,
(b1) to provide the Minister with such information as the Minister may request,
(c) to publicise and disseminate information concerning the Scheme,
(d) to issue and keep under review the LTCS Guidelines under this Act.
(e), (f) (Repealed)
(3) The Authority has the following functions in relation to the provision of care, treatment, rehabilitation, long term support and other services for persons who have sustained motor accident injuries—
(a) to monitor those services,
(b) to provide support and funding for programs that will improve delivery of those services,
(c) to provide support and funding for research and education in connection with the delivery of those services.
(4), (5) (Repealed)
s 43: Am 2012 No 54, Sch 3.2 [12] [13]; 2015 No 19, Sch 8 [8] [9].
43A
Functions of the Authority under other care and support schemes
43A Functions of the Authority under other care and support schemes
43A Functions of the Authority under other care and support schemes
(1) The Authority may, with the approval of the Minister and the Treasurer, enter into an arrangement (a care and support arrangement) that provides for the Authority to exercise all or specified functions of a relevant authority under a care and support scheme that is prescribed by the regulations for the purposes of this section.
(2) A care and support arrangement is to be entered into by agreement between the Authority and the relevant authority concerned and can include provision for or with respect to any matter that is necessary or convenient in connection with the conferring of functions on the Authority including (without limitation) any of the following matters—
(a) the manner in which the Authority is to exercise functions under the arrangement,
(b) the administrative arrangements for the exercise of functions under the arrangement, including funding arrangements,
(c) the sharing of information between the Authority and the relevant authority in connection with the operation of the arrangement and the exercise of functions under the arrangement,
(d) such other matters as may be prescribed by the regulations.
(3) The Authority has the functions provided for by a care and support arrangement entered into under this section and is to exercise those functions in accordance with the arrangement. Functions exercised by the Authority under a care and support arrangement are exercised for and on behalf of the relevant authority.
(4) A care and support arrangement can provide for the exercise of functions by the Authority outside the State.
(4A) This section does not apply to the functions of the Authority under the Motor Accident Injuries Act 2017 or any agreement with the Authority under that Act.
(5) In this section—
care and support scheme means a law of the State or of another State or Territory or of the Commonwealth that makes provision for—
(a) a scheme that is substantially the same as or similar to the Scheme under this Act, or
(b) a scheme for the payment of compensation or the provision of other care and support to persons who have suffered injury (whether or not caused by a motor accident).
relevant authority means a person or body that has functions under a care and support scheme (including functions under a contract of insurance required or provided for by a care and support scheme).
s 43A: Ins 2014 No 77, Sch 1 [3]. Am 2017 No 10, Sch 5.10 [4].
Division 4
Division 4
Division 4
44–46 (Repealed)
pt 6, div 4: Rep 2012 No 54, Sch 3.2 [14].
s 44: Rep 2012 No 54, Sch 3.2 [14].
s 45: Am 2010 No 98, Sch 2 [2] [3]. Rep 2012 No 54, Sch 3.2 [14].
(1) There is established a fund, to be known as the Lifetime Care and Support Authority Fund, belonging to and vested in the Authority.
(2) The following is to be paid into the Fund—
(a) the appropriate proportion of the money contributed by third-party policy holders under Division 10.4 of the Motor Accident Injuries Act 2017 in respect of a relevant period (being the proportion that is the required contribution to the Fund determined under section 49 in respect of that relevant period),
(b) the interest from time to time accruing from the investment of the Fund,
(c) money required to be paid into the Fund by or under this or any other Act,
(c1) (Repealed)
(d) all other money received by the Authority and not otherwise appropriated.
(3) The following is to be paid from the Fund—
(a) all payments required to be made by the Authority under Part 2A (Payments under Scheme),
(b) all payments required to meet expenditure incurred by or on behalf of a NSW Government agency in providing services (including staff and facilities) for or in connection with the Scheme,
(b1) all payments (as approved by the Minister administering Part 3 of the State Insurance and Care Governance Act 2015) required to meet expenditure incurred by the State Insurance Regulatory Authority in exercising functions in connection with the Scheme,
(c) (Repealed)
(d) all payments required to meet expenditure incurred in relation to the functions of the Authority, where money is not otherwise provided for that purpose,
(e) all other money required by or under this or any other Act to be paid from the Fund.
(3A) (Repealed)
(4) The Authority may invest money in the Fund that is not immediately required for the purposes of the Fund—
(a) if the Authority is a GSF agency for the purposes of Part 6 of the Government Sector Finance Act 2018—in any way that the Authority is permitted to invest money under that Part, or
(b) if the Authority is not a GSF agency for the purposes of Part 6 of the Government Sector Finance Act 2018—in any way approved by the Minister with the concurrence of the Treasurer.
s 48: Am 2009 No 96, Sch 14 [6]; 2012 No 48, Sch 1 [7]; 2012 No 54, Sch 3.2 [15]–[19]; 2015 No 19, Sch 8 [10]–[12]; 2017 No 10, Sch 5.10 [5]; 2018 No 70, Sch 3.44.
48A
Separate accounting for care and support arrangements
48A Separate accounting for care and support arrangements
48A Separate accounting for care and support arrangements
(1) Each care and support arrangement is to have a separate account established for it within the Fund.
(2) Amounts payable to or by the Authority under a care and support arrangement are to be accounted for separately within the Fund by being paid into or from the separate account established for the arrangement.
(3) A liability of the Authority under a care and support arrangement is not a liability of the Fund except to the extent that the liability can be satisfied out of money standing to the credit of the separate account established for the arrangement within the Fund.
(4) Accordingly, an amount required to be paid under a care and support arrangement can only be paid from the separate account established for the arrangement but this does not prevent the use of other money in the Fund for the payment of such an amount pursuant to the provision of temporary financial accommodation (including by the making of an advance to the separate account established for the arrangement) that is repaid from the separate account.
(5) The Authority is to have no regard to a liability of the Authority under a care and support arrangement in making a determination under section 49 (Determination by Authority of amount to be contributed to Fund).
(6) In this section—
care and support arrangement means a care and support arrangement entered into under section 43A.
s 48A: Ins 2014 No 77, Sch 1 [4].
49
Determination by Authority of amount to be contributed to Fund
49 Determination by Authority of amount to be contributed to Fund
49 Determination by Authority of amount to be contributed to Fund
(1) The Authority is to determine, before the beginning of each relevant period, the amount required to be contributed to the Fund—
(a) to fully fund the present and likely future liabilities of the Authority under Part 2A (Payments under Scheme) in respect of persons who become participants in the Scheme in respect of motor accident injuries suffered during that period, and
(b) to meet the payments required to be made from the Fund (other than payments under Part 2A) during that period, and
(c) to make provision for such other matters as the Authority should, in all the circumstances, prudently make provision for in connection with liabilities under Part 2A.
(2) The amount required to fully fund a liability of the Authority under Part 2A is an amount that is sufficient to provide a sum of money that together with anticipated investment income is equal to the best estimate of the cost of meeting the liability (in inflated dollars) as and when the liability falls due.
(3) The Authority’s determination in respect of a relevant period is to be made in accordance with the report of an independent actuary engaged by the Authority to report to the Authority on the amount required to be contributed to the Fund as referred to in subsection (1).
(4) A relevant period is a financial year or such other period as the Authority determines from time to time to be a relevant period for the purposes of this section. Relevant periods can be determined so as to overlap but there must be no gap between successive relevant periods and each relevant period must not be longer than 12 months.
(5) The amount determined by the Authority under this section for a relevant period is the required Fund contribution for that period.
Note.
The required Fund contribution is contributed as part of the Fund levy under Division 10.4 of the Motor Accident Injuries Act 2017.
s 49: Am 2012 No 48, Sch 1 [7] [8]; 2015 No 19, Sch 8 [13]; 2017 No 10, Sch 5.10 [6].
50
50
50–53 (Repealed)
54
Recovery of lifetime care and support payments—uninsured and interstate vehicles and third party tortfeasors
54 Recovery of lifetime care and support payments—uninsured and interstate vehicles and third party tortfeasors
54 Recovery of lifetime care and support payments—uninsured and interstate vehicles and third party tortfeasors
(1) The Authority is entitled to recover from the appropriate person as a debt due to the Authority the present value of its treatment and care liabilities in respect of the motor accident injury of a participant in the Scheme if—
(a) the injury was caused by the fault of the owner or driver of a motor vehicle in the use or operation of the vehicle, and
(b) at the time of the motor accident there was no third-party policy in force in relation to the motor vehicle concerned.
(2) If the participant suffered the motor accident injury as a result partly of the participant’s contributory negligence, the amount that the Authority is entitled to recover under this section is to be reduced in proportion to the participant’s share in the responsibility for the injury.
(3) If the participant suffered the motor accident injury as a result partly of the fault of a person (other than the owner or driver of a motor vehicle), the Authority is entitled to recover from that person as a debt due to the Authority such proportion of the present value of its treatment and care liabilities in respect of the injury as corresponds to the person’s share in the responsibility for the injury.
(4) The present value of the Authority’s treatment and care liabilities in respect of a motor accident injury is the sum of the following amounts—
(a) amounts already paid by the Authority under Part 2A in respect of the treatment and care needs associated with the motor accident injury,
(b) the present value of the amounts that the Authority estimates will become payable by the Authority in the future under Part 2A in respect of the treatment and care needs associated with the motor accident injury.
(5) The appropriate person from whom the Authority may recover is—
(a) unless paragraph (b) applies—the person who at the time of the motor accident was the owner of the motor vehicle or, if at that time some other person was driving the motor vehicle, the owner and the driver jointly or either of them severally, or
(b) if the motor vehicle was at the time of the motor accident subject to coverage under a policy of compulsory third-party personal injury insurance or a compulsory motor vehicle accident compensation scheme under the law of a place other than New South Wales or under a law of the Commonwealth—the insurer under that policy or the person liable under that scheme.
(6) The Authority is entitled to recover under this section in respect of a motor accident injury of a participant in the Scheme only if the injury is an injury to which Chapter 3 of the Motor Accidents Compensation Act 1999 applies (as provided by section 3B of that Act).
(7) It is a sufficient defence in any proceedings to recover under this section against the owner (whether severally or jointly with the driver) of a motor vehicle if the owner establishes to the satisfaction of the court that, at the time of the occurrence, some other person was driving the motor vehicle without the owner’s authority.
(8) It is a sufficient defence in any proceedings to recover under this section against the driver of a motor vehicle (whether severally or jointly with the owner) if the driver establishes to the satisfaction of the court that, at the time of the occurrence, the driver was driving the motor vehicle with the authority of the owner (or had reasonable grounds for believing and did in fact believe that the driver had such authority) and that the driver had reasonable grounds for believing and did in fact believe that a third-party policy was in force in relation to the motor vehicle.
(9) The Authority is not entitled to recover under this section from the owner or driver of a motor vehicle that, at the relevant time, was not required to be registered or was exempt from registration or, if required to be registered, was not required to be insured under the Motor Accidents Compensation Act 1999.
(10) The certificate of the Authority as to the present value of the Authority’s treatment and care liabilities in respect of a motor accident injury is evidence of the matters certified for the purposes of any proceedings in connection with this section.
(11) This section does not permit the Authority to recover the present value of its treatment and care liabilities in respect of injuries to a participant in the Scheme if the participant paid an amount to the Authority under section 7A (1) in respect of those injuries.
s 54: Am 2009 No 33, Sch 1 [5]; 2012 No 48, Sch 1 [8].
55
55
55 (Repealed)
Part 8
Miscellaneous
Part 8 Miscellaneous
Part 8 Miscellaneous
56
No contracting out of Act
56 No contracting out of Act
56 No contracting out of Act
This Act applies despite any contract to the contrary.
57
Act to bind Crown
57 Act to bind Crown
57 Act to bind Crown
This Act binds the Crown, not only in right of New South Wales but also, so far as the legislative power of Parliament permits, the Crown in all its other capacities.
58
LTCS Guidelines
58 LTCS Guidelines
58 LTCS Guidelines
(1) The Authority may issue guidelines (LTCS Guidelines) for or with respect to any matter that by this Act is required or permitted to be the subject of those guidelines.
(2) The Authority may amend, revoke or replace LTCS Guidelines.
(3) LTCS Guidelines may adopt the provisions of other publications, whether with or without modification or addition and whether in force at a particular time or from time to time.
(4) LTCS Guidelines (including any amendment, revocation or replacement) are to be published in the Gazette and take effect on the day of that publication or, if a later day is specified in the guidelines for that purpose, on the day so specified.
(5) Sections 40 (Notice of statutory rules to be tabled) and 41 (Disallowance of statutory rules) of the Interpretation Act 1987 apply to a guideline under this section in the same way as those sections apply to a statutory rule.
Editorial note.
For guidelines issued pursuant to this section see Gazettes No 118 of 22.9.2006, p 8155; No 132 of 28.9.2007, p 7511; No 119 of 8.10.2010, p 5105; No 54 of 25.5.2012, pp 2245, 2248, 2251, 2253, 2254, No 126 of 19.12.2014, p 4704 and No 124 of 21.11.2018, n2018-3969. From April 2021, PCO is no longer updating notes in provisions of in force titles about related gazette notices. To search for related gazette notices, please use the Gazette Search functionality.
59
Service of documents on Authority or Advisory Council
59 Service of documents on Authority or Advisory Council
59 Service of documents on Authority or Advisory Council
(1) A document may be served on the Authority by leaving it at, or by sending it by post addressed to, the Authority’s office or, if it has more than one office, any of its offices.
(2) Nothing in this section affects the operation of any provision of a law or of the rules of a court authorising a document to be served on the Authority in any other manner.
s 59: Am 2012 No 54, Sch 3.2 [18].
60
Exchange of information
60 Exchange of information
60 Exchange of information
The Authority is authorised to exchange information concerning the treatment and care needs of participants (including the expenses that are paid or payable by the Authority under the Scheme in relation to those needs) with licensed insurers within the meaning of the Motor Accidents Compensation Act 1999 and such other persons or bodies as may be approved by the Authority.
61
61
61 (Repealed)
62
Protection of assessors
62 Protection of assessors
62 Protection of assessors
(1) A matter or thing done or omitted to be done by an assessor under Part 3 or 4 in the exercise of the assessor’s functions does not, if the matter or thing was done or omitted in good faith, subject the assessor personally to any action, liability, claim or demand.
(2) An assessor under Part 3 or 4 is, in any legal proceedings, competent but not compellable to give evidence or produce documents in respect of any matter in which he or she was involved in the course of the exercise of his or her functions as an assessor.
(3) Any liability that would attach to a person were it not for the operation of subsection (1) attaches instead to the Crown.
63
Regulations
63 Regulations
63 Regulations
The Governor may make regulations, not inconsistent with this Act, for or with respect to any matter that by this Act is required or permitted to be prescribed or that is necessary or convenient to be prescribed for carrying out or giving effect to this Act.
64
Nature of proceedings for offences
64 Nature of proceedings for offences
64 Nature of proceedings for offences
Proceedings for an offence under this Act or the regulations may be dealt with summarily before the Local Court.
s 64: Am 2007 No 94, Sch 2.
65
65
65 (Repealed)
66
Auditor-General to report on Costing Study
66 Auditor-General to report on Costing Study
66 Auditor-General to report on Costing Study
(1) In this section—
Costing Study means the study entitled NSW CTP No-Fault Long Term Care Costing Study prepared by PricewaterhouseCoopers Actuarial Pty Ltd (ACN 003 562 696) and issued on 17 June 2005, which forms the Appendix to the New South Wales Government publication entitled Lifetime care and support for people with a catastrophic injury from a motor vehicle accident(ISBN 1 876958 22 7) issued by the Motor Accidents Authority in June 2005.
(2) The Auditor-General is to conduct a review of the Costing Study in order to determine whether the assumptions and costing projections set out in the Study are soundly based.
(3) The Auditor-General must, as soon as practicable after the expiration of the period of 6 months commencing on the date of assent to this Act, prepare a report on the conclusions reached on that review and furnish a copy of the report to the Minister.
(4) The Minister is to lay (or cause to be laid) a copy of the report before both Houses of Parliament as soon as practicable after the Minister receives the report.
(5) If a House of Parliament is not sitting when the Minister seeks to lay a report before it, the Minister may present copies of the report to the Clerk of the House concerned.
(6) The report—
(a) is, on presentation and for all purposes, taken to have been laid before the House, and
(b) may be printed by authority of the Clerk of the House, and
(c) if so printed, is for all purposes taken to be a document published by or under the authority of the House, and
(d) is to be recorded—
(i) in the case of the Legislative Council, in the Minutes of the Proceedings of the Legislative Council, and
(ii) in the case of the Legislative Assembly, in the Votes and Proceedings of the Legislative Assembly,
on the first sitting day of the House after receipt of the report by the Clerk.
67
Review of Act
67 Review of Act
67 Review of Act
(1) The Minister is to review this Act to determine whether the policy objectives of the Act remain valid and whether the terms of the Act remain appropriate for securing those objectives.
(2) The review is to be undertaken as soon as possible after the period of 5 years from the date of assent to this Act.
(3) A report on the outcome of the review is to be tabled in each House of Parliament within 12 months after the end of the period of 5 years.
68
68
68 (Repealed)
Schedule 1
Provisions relating to chief executive
Schedule 1 Provisions relating to chief executive
Schedule 1 Provisions relating to chief executive
(Section 39)
sch 1: Am 2010 No 98, Sch 2 [4]. Rep 2012 No 54, Sch 3.2 [20]. Ins 2015 No 19, Sch 8 [16].
Schedule 2
Schedule 2
Schedule 2 (Repealed)
sch 2: Am 2010 No 98, Sch 2 [5]. Rep 2012 No 54, Sch 3.2 [21].
Schedule 3
Savings, transitional and other provisions
Schedule 3 Savings, transitional and other provisions
Schedule 3 Savings, transitional and other provisions
sch 3: Subst 2009 No 33, Sch 1 [7]. Am 2010 No 98, Sch 2 [6]; 2012 No 48, Sch 1 [9] [10]; 2015 No 19, Sch 8 [17].
Source text: opening excerpt
Sourced from legislation.nsw.gov.au, CC BY 4.0.
Part 1 Preliminary
Part 1 Preliminary
Part 1 Preliminary
1 Name of Act
1 Name of Act
1 Name of Act
This Act is the Motor Accidents (Lifetime Care and Support) Act 2006.
2 Commencement
2 Commencement
2 Commencement
(1) This Act commences on a day or days to be appointed by proclamation, except as provided by subsection (2).
(2) Section 66 (Auditor-General to report on Costing Study) commences on the date of assent to this Act.
3 Definitions
3 Definitions
3 Definitions
(1) In this Act—
approved provider—see section 11C (2).
assessed treatment and care needs—see section 11A (2).
attendant care services means services that aim to provide assistance to people with everyday tasks, and includes (for example) personal assistance, nursing, home maintenance and domestic services.
Authority means the Lifetime Care and Support Authority of New South Wales constituted by this Act.
chief executive means the chief executive of the Authority appointed under this Act.
excluded treatment and care needs—see section 5A (2).
Fund means the Lifetime Care and Support Authority Fund established by this Act.
insurer of a claim means an insurer for the purposes of Chapter 4 (Motor accident claims) of the Motor Accidents Compensation Act 1999 in relation to the claim.
LTCS Guidelines means guidelines issued by the Authority under section 58, as in force from time to time.
motor accident injury means injury caused by a motor accident.
Note.
Section 4 provides for the motor accident injuries to which this Act applies.
participant in the Scheme means a person accepted as provided by this Act as a participant in the Scheme (either as a lifetime participant or as an interim participant).
relevant Scheme commencement date, with respect to a person who has suffered motor accident injuries, means—
(a) 1 October 2006 if the person was under 16 years of age at the time of the motor accident that caused the injuries, or
The Act also creates mechanisms to prevent overlap with common-law damages. A person who has received a final judgment or binding settlement for future economic loss relating to treatment and care needs is ineligible (s 7(3)). While a person is an interim participant, limitation periods under the Motor Accidents Compensation Act 1999 (MAC Act) s 109 and the Limitation Act 1969 are suspended (s 11(2)).
Funding is secured through an annual actuarial determination (s 49). Before each “relevant period” the Authority must calculate the amount required to fully fund present and future liabilities under Part 2A, meet other Fund expenses, and make prudent provision for contingencies. That amount is recovered as part of the motor accident insurance levy imposed on third-party policies under the Motor Accident Injuries Act 2017 (s 48(2)(a)). The Authority maintains the Lifetime Care and Support Authority Fund (s 48) and may recover the present value of its treatment and care liabilities from uninsured owners or drivers, interstate insurers, or other tortfeasors (s 54).
Administrative machinery includes power to issue LTCS Guidelines (s 58), appoint assessors (ss 13, 23), approve providers of attendant care and other nominated services (s 11C), enter bulk-billing arrangements with hospitals and ambulance services (s 30), and fix maximum fees by regulation (s 32). The Authority may also enter “care and support arrangements” to exercise functions under comparable schemes in other jurisdictions (s 43A), with separate accounting within the Fund (s 48A).
In short, the Act replaces adversarial damages litigation for care costs with a streamlined, administratively assessed, lifelong support system funded collectively by motorists.
Who it affects
The primary beneficiaries are individuals who suffer “motor accident injuries” (defined in s 3 as injury caused by a motor accident) that satisfy the LTCS Guidelines eligibility criteria (s 7(1)). The Act applies only to injuries resulting from accidents occurring on or after the relevant Scheme commencement date—1 October 2006 for those under 16 at the time of accident, and 1 October 2007 otherwise (s 4(1))—and only to accidents in New South Wales (s 4(2)), subject to the “buy-in” exceptions in ss 7A and 7B.
Eligibility is injury-based rather than fault-based. Section 4(4) expressly provides that the Act applies “whether or not the injury was caused by the fault of the owner or driver … and so applies even if the injured person was at fault”. However, a person who has already been awarded damages for future economic loss relating to treatment and care needs is barred (s 7(3)).
Insurers under the MAC Act Chapter 4 play a procedural role. They may lodge applications for participation (s 8(1)), are obliged to do so if directed by the State Insurance Regulatory Authority (s 8(3)), and may refer eligibility disputes to an Assessment Panel (s 14(2)). The Nominal Defendant is an “interested person” for the purpose of disputes about whether an injury is a motor accident injury (s 20(2)(c)).
The Authority itself is the central administrator. It is constituted as a statutory corporation representing the Crown (s 33), managed by a Ministerially appointed chief executive (s 39), and funded by the Lifetime Care and Support Authority Fund (s 48). Its staff, delegates, assessors and Review Panel members exercise statutory powers that affect participants’ entitlements.
Health professionals, approved providers of attendant care services (s 11C), hospitals, ambulance services and rehabilitation providers are directly affected by payment rules, bulk-billing arrangements (s 30), maximum fee regulations (s 32) and the prohibition on payment for gratuitous or non-approved services (s 11B).
Finally, all NSW motorists contribute indirectly through the levy component of their compulsory third-party insurance premiums that funds the required Fund contribution determined under s 49.
Key duties and rights
Participants have the right to have their “assessed treatment and care needs” funded for life if they are lifetime participants, or for the interim period if they are interim participants (s 11A). They are entitled to an assessment conducted in accordance with the LTCS Guidelines (s 23) and to written reasons (s 23(4)). They may dispute the Authority’s assessment within 28 days (s 24(2)), receive a further determination from an assessor, and request review by a Review Panel on the grounds listed in s 25(1). A participant must, however, cooperate with reasonable requests for examination (s 27); failure to do so may affect entitlements.
The Authority’s key duties are to determine eligibility (s 9), conduct needs assessments (s 23), pay only for reasonable and necessary needs that relate to the motor accident injury and are not excluded (s 11A(2)–(3)), use approved providers for attendant care and nominated services (s 11C(1)), and observe the rules in ss 11B and 11AA concerning gratuitous services and alternative cost-effective expenditure. It must also maintain the Fund, make the actuarial determination required by s 49, and issue and keep under review the LTCS Guidelines (s 43(2)(d)).
Insurers have a duty to comply with a direction from the State Insurance Regulatory Authority to lodge an application (s 8(3)) and may be required to pay the costs of any assessment mandated by the Guidelines (s 8(6)(b)).
Assessors and Review Panel members must act in accordance with the LTCS Guidelines and provide written reasons and certificates (ss 14(4), 15(4), 24(4), 25(4)). Their determinations on eligibility are final and binding (s 16); determinations on needs assessments bind the Authority, which must revise its own assessment accordingly (s 26(2)).
The Act confers rights of recovery on the Authority. Under s 54 it may recover the present value of its treatment and care liabilities from uninsured owners/drivers, interstate insurers or other tortfeasors, with proportionate reduction for contributory negligence.
Participants retain the right to pursue damages claims under the MAC Act for economic loss other than treatment and care needs, subject to the limitation suspension while they are interim participants (s 11).
Penalties and enforcement
The Act is not primarily offences-based. Section 64 provides that proceedings for any offence under the Act or regulations are to be dealt with summarily before the Local Court. However, the printed text does not contain specific offence-creating provisions; enforcement is largely administrative and civil.
The principal sanctions are financial. The Authority may refuse payment for treatment provided by non-approved providers (s 11B(1)(b)) or on a gratuitous basis (s 11B(1)(a)), although it retains a discretion to pay in “special circumstances” (s 11B(2)). A legal practitioner who charges more than the maximum legal costs fixed by regulation for disputes under Division 2 of Part 3 commits a breach; the excess is irrecoverable (s 21(4)).
The Authority’s recovery action under s 54 is a debt recoverable in a court of competent jurisdiction. The certificate of the Authority as to the present value of its liabilities is prima-facie evidence (s 54(10)). Defences are narrowly framed: an owner may prove the vehicle was driven without authority (s 54(7)); a driver may prove reasonable belief that a third-party policy was in force (s 54(8)).
Directions given by the Minister under s 38 are mandatory; the Authority must comply and report them in its annual report. Delegations under s 41 must stay within the statutory boundaries.
Breach of the prohibition on contracting out (s 56) renders any contrary contractual term unenforceable. The Crown is bound (s 57).
How it interacts with other laws
The Act is expressly linked to the Motor Accidents Compensation Act 1999 (MAC Act). Undefined terms take their MAC Act meaning (s 5). Eligibility is confined to injuries to which Chapter 3 of the MAC Act applies (s 54(6)). Dispute resolution for whether an injury is a “motor accident injury” is referred to the Personal Injury Commission under Part 4.4 of the MAC Act (s 20(3)), with costs determined under the special regime in s 21 that prevails over the legal costs legislation (s 21(6)).
The Motor Accident Injuries Act 2017 supplies the levy mechanism that funds the required Fund contribution (s 48(2)(a) and note to s 49). Section 43A(4A) expressly excludes the 2017 Act from care-and-support arrangements.
Limitation periods under the Limitation Act 1969 are suspended during interim participation (s 11(2)). The Interpretation Act 1987 applies to undefined terms and to the LTCS Guidelines, which are treated as statutory rules for tabling and disallowance (s 58(5)).
The Government Sector Finance Act 2018 governs the Authority’s financial year and investment powers (ss 37, 48(4)). The Legal Profession Uniform Law (NSW) supplies the definitions of “legal services” and “legal costs” used in ss 18, 21 and 29.
The Act prevails over any contrary contract (s 56) and binds the Crown in all capacities (s 57). It interacts with the State Insurance and Care Governance Act 2015 through ministerial oversight and funding approvals (s 48(3)(b1)).
Savings and transitional provisions in Schedule 3 ensure that amendments made by the 2009, 2010, 2012 and later Acts apply to claims made on or after the relevant date even if the accident occurred earlier.
Recent changes and why
The Act has been amended on multiple occasions to address practical difficulties, expand access and improve fiscal sustainability.
The Motor Accidents (Lifetime Care and Support) Amendment Act 2009 inserted s 7A (pre-commencement “buy-in”), amended eligibility and participation rules, and adjusted interim participation durations for young children (now reflected in ss 9(5A)–(5B) and Schedule 3 clause 2). The change responded to families who would have qualified but for the commencement cut-off.
The Motor Accidents and Lifetime Care and Support Schemes Legislation Amendment Act 2012 was the most substantial rewrite. It repealed the former s 6 and s 10, inserted the current Part 2A (ss 11A–11C), redefined “treatment and care needs”, introduced the approved-provider regime, clarified that only assessed needs are funded, and added the option of contributing to alternative cost-effective expenditure (later expanded by s 11AA in 2014). These changes addressed cost blow-outs, quality control of attendant care, and the administrative burden of paying for every incidental expense. The Act also amended the funding provisions and inserted comprehensive transitional rules in Schedule 3 Part 3.
In 2015 the State Insurance and Care Governance Act 2015 and associated statutes transferred oversight functions, replaced references to the Motor Accidents Authority with the Authority or State Insurance Regulatory Authority, and adjusted ministerial direction powers (s 38).
The Motor Accident Injuries Act 2017 integrated the levy collection mechanism into the new CTP framework (s 48(2)(a)).
Section 7B (out-of-state buy-in) was added in 2017 to extend the scheme’s reach on a fully-funded basis. Section 43A (care-and-support arrangements) was inserted in 2014 to allow the Authority to act as administrator for other no-fault schemes, improving efficiency through economies of scale.
Each change has been driven by actuarial experience, stakeholder feedback on access barriers, and the desire to maintain the Scheme’s long-term financial viability without compromising care standards.
Court challenges and controversies
Because eligibility and needs assessments are declared final and binding (ss 16, 26), judicial review has been the main avenue of challenge. Courts have examined whether the Authority has asked itself the correct statutory question, whether it has had regard to the LTCS Guidelines, and whether procedural fairness has been afforded in the assessment process. The text itself does not record specific decisions, but the structure of the dispute-resolution Parts (detailed time limits, limited review grounds, certificate requirements) reflects legislative intent to minimise litigation.
Controversies have centred on the breadth of “reasonable and necessary” (s 11A(2)(a)), the boundary between treatment needs arising from the motor accident and those arising from pre-existing or subsequent conditions, and the adequacy of attendant-care funding for profoundly disabled participants. The introduction of the approved-provider regime (s 11C) and the prohibition on gratuitous services (s 11B) generated debate about choice of carer and potential cost-shifting to families.
The recovery provision in s 54 has raised questions about the calculation of “present value” of future liabilities and the interaction with contributory negligence reductions. The ability of the Authority to pursue uninsured drivers or third-party tortfeasors has been criticised by some as double recovery, although the Act’s structure makes clear that the participant’s damages claim is preserved for heads of damage other than funded care.
The expansion via ss 7A and 7B has prompted discussion about whether the Scheme remains true to its original “no-fault, compulsory levy” philosophy when it accepts voluntary contributions from persons outside the compulsory insurance pool.
Gotchas
Most practitioners assume that once a person is accepted as a lifetime participant the Authority must fund every conceivable expense. Section 11A(2) limits payment to needs that are both “reasonable and necessary in the circumstances” and relate to the motor accident injury; the LTCS Guidelines contain detailed criteria that can result in partial or declining funding. The final-and-binding status of assessments (s 26(1)) means the window to challenge is narrow—28 days for the initial request for assessor review (s 24(2)) and a further 28 days for Review Panel (s 25(2)).
Another trap is s 11B: even if a need is assessed, the Authority is not required to pay for gratuitous services or services provided by a non-approved provider unless special circumstances are found. Families who arrange informal care without first obtaining approval risk non-reimbursement.
The interaction with damages claims is frequently misunderstood. A binding settlement that includes an amount for future treatment and care needs bars eligibility entirely (s 7(3)). Conversely, interim participation suspends limitation periods (s 11(2)), but only while the person remains an interim participant; once upgraded to lifetime status the clock may restart for any residual common-law claim.
Section 54 recovery can catch insurers and owners by surprise. The Authority’s certificate is evidence of the present value; the onus then shifts to the defendant to prove any defence under ss 54(7)–(9). The proportionate reduction for contributory negligence applies, but only to the participant’s share; the Authority can still pursue other tortfeasors for their share (s 54(3)).
The LTCS Guidelines are not reproduced in the Act; they are published in the Gazette and amended from time to time (s 58). Failure to consult the current version when advising on eligibility or needs can lead to erroneous advice. Similarly, the list of “excluded treatment and care needs” is set by regulation, not the Act.
Finally, the Authority’s power under s 43A to administer other schemes means that staff may be exercising functions under interstate legislation; practitioners must check which funding stream and which legal test applies to a particular service.
How to comply
Compliance for participants and their advisers begins with timely lodgement of an application in the Authority’s approved form (s 8(4)). Where an insurer has conduct of a claim it should consider whether a direction under s 8(3) is likely and may elect to lodge voluntarily. All supporting medical and allied-health evidence should be assembled to demonstrate that the injury meets the LTCS Guidelines eligibility criteria.
Once accepted, participants should cooperate with every reasonable request for examination (s 27). They should obtain prior approval for attendant care providers (s 11C) and submit treatment plans that align with the most recent LTCS Guidelines criteria for “reasonable and necessary”. Requests for home modifications or vehicle adaptations should be supported by occupational-therapy reports that expressly link the modification to the motor accident injury.
Service providers must register as approved providers where required and invoice the Authority directly; they cannot bill the participant for the difference between their charge and the regulated maximum (s 32). Hospitals and ambulance services should utilise bulk-billing arrangements (s 30) wherever possible to avoid the slower individual-claim route under s 31.
Insurers and legal practitioners must be alert to the 28-day time limits for disputing needs assessments. Any referral to an assessor or Review Panel must be framed strictly within the grounds listed in ss 24–25; additional information must be shown to have been unavailable earlier.
For the Authority, compliance requires rigorous actuarial modelling before each relevant period (s 49(3)), maintenance of separate accounts for care-and-support arrangements (s 48A), and publication of up-to-date LTCS Guidelines (s 58). Delegations (s 41) and ministerial directions (s 38) must be meticulously documented.
Organisations seeking to contract with the Authority should ensure their staff and systems meet the competency standards referenced in the Guidelines (s 11C(3)). All parties should maintain records that demonstrate causal connection to the motor accident injury, because the Authority is entitled to decline payment for unrelated needs (s 11A(2)(b)).
In practice, early engagement with the Authority’s case managers, use of the published Guidelines, and careful sequencing of any residual common-law claim against the limitation suspension period are the keys to maximising entitlement while minimising dispute.
the Scheme means the scheme provided for by this Act for the lifetime care and support of persons injured in motor accidents.
treatment and care needs—see section 5A.
treatment and care needs assessment means an assessment under Part 4 of the treatment and care needs of a participant in respect of the participant’s motor accident injury.
Note.
The Interpretation Act 1987 contains definitions and other provisions that affect the interpretation and application of this Act.
(2) Notes included in this Act do not form part of this Act.
s 3: Am 2009 No 33, Sch 1 [1]; 2009 No 96, Sch 14 [1]; 2012 No 48, Sch 1 [1] [2]; 2012 No 54, Sch 3.2 [1]–[3]; 2015 No 19, Sch 8 [1] [2].
4 Application of Act
4 Application of Act
4 Application of Act
(1) This Act applies only in respect of motor accident injuries suffered by a person as a result of a motor accident occurring on or after the relevant Scheme commencement date.
Note.
Section 7A provides for a limited exception to this provision.
(2) This Act applies only in respect of motor accident injuries resulting from motor accidents occurring in New South Wales.
Note.
Section 7B provides for a limited exception to this provision.
(3) This Act applies in respect of a motor accident injury only if there is a motor vehicle involved in the motor accident concerned that has motor accident insurance cover for the motor accident (within the meaning of section 3B of the Motor Accidents Compensation Act 1999), whether or not all the motor vehicles involved in the motor accident have motor accident insurance cover for the motor accident.
(4) This Act applies in respect of a motor accident injury whether or not the injury was caused by the fault of the owner or driver of the motor vehicle in the use or operation of the vehicle or of any other person and so applies even if the injured person was at fault (whether as owner or driver of the vehicle or otherwise).
(5) The regulations may make provision (including provision of a savings or transitional nature) for or with respect to limiting the application of this Act or any specified provisions of this Act to specified classes of persons.
s 4: Am 2009 No 33, Sch 1 [2]; 2017 No 10, Sch 5.10 [1].
Words and expressions used (but not defined) in this Act have the same meanings as in the Motor Accidents Compensation Act 1999.
5A Treatment and care needs
5A Treatment and care needs
5A Treatment and care needs
(1) For the purposes of this Act, the treatment and care needs of a participant in the Scheme are the participant’s needs for or in connection with any of the following—
(a) medical treatment (including pharmaceuticals),
(b) dental treatment,
(c) rehabilitation,
(d) ambulance transportation,
(e) respite care,
(f) attendant care services,
(g) aids and appliances,
(h) prostheses,
(i) education and vocational training,
(j) home and transport modification,
(k) workplace and educational facility modifications,
(l) such other kinds of treatment, care, support or services as may be prescribed by the regulations under this paragraph.
(2) Despite subsection (1), the treatment and care needs of a participant do not include any treatment, care, support or services of a kind declared by the regulations to be excluded treatment and care needs.
s 5A: Ins 2012 No 48, Sch 1 [3].
Part 2 Participation in Scheme
Part 2 Participation in Scheme
Part 2 Participation in Scheme
pt 2, hdg: Subst 2012 No 48, Sch 1 [4].
6
6 (Repealed)
6
s 6: Rep 2012 No 48, Sch 1 [5].
7 Eligibility for participation in the Scheme
7 Eligibility for participation in the Scheme
7 Eligibility for participation in the Scheme
(1) A person who has suffered a motor accident injury is eligible to be a participant in the Scheme in respect of the injury if the person’s injury satisfies the criteria specified in the LTCS Guidelines for eligibility for participation in the Scheme.
(2) Participation in the Scheme may be as a lifetime participant or an interim participant and for that purpose the LTCS Guidelines are to establish criteria for eligibility for lifetime participation and criteria for eligibility for interim participation in the Scheme.
(3) A person is not eligible to be a participant in the Scheme in relation to an injury if the person has been awarded damages, pursuant to a final judgment entered by a court or a binding settlement, for future economic loss in respect of the treatment and care needs of the participant that relate to the injury.
(4) The LTCS Guidelines may make provision for or with respect to eligibility for participation in the Scheme, including provision for or with respect to the criteria that a motor accident injury must satisfy for the injured person to be eligible for participation in the Scheme in respect of the injury and the determination of whether a motor accident injury satisfies those criteria.
7A Persons injured before commencement of Scheme may “buy in”
7A Persons injured before commencement of Scheme may “buy in”
7A Persons injured before commencement of Scheme may “buy in”
(1) A person who has suffered a motor accident injury as a result of a motor accident occurring before the relevant Scheme commencement date (a pre-commencement injury) may be accepted as a lifetime participant in the Scheme if the person pays to the Authority, for payment into the Fund, a contribution determined by the Authority.
(2) The contribution is to be the amount that the Authority determines as the amount required to fund the treatment and care needs of the person as a lifetime participant in the Scheme in respect of the injury.
(3) A person is eligible to participate in the Scheme in respect of a pre-commencement injury only if the person would have been eligible to participate in the Scheme—
(a) had the motor accident occurred immediately after the relevant Scheme commencement date, and
(b) if the person has been awarded damages in respect of the injury—had those damages not been awarded.
(4) An application for a person to become a participant in the Scheme in respect of a pre-commencement injury cannot be made by an insurer.
(5) The LTCS Guidelines may make provision for or with respect to how a person’s contribution for participation in the Scheme in respect of a pre-commencement injury is to be determined.
s 7A: Ins 2009 No 33, Sch 1 [3].
7B Persons injured in motor accidents occurring outside NSW may “buy in”
7B Persons injured in motor accidents occurring outside NSW may “buy in”
7B Persons injured in motor accidents occurring outside NSW may “buy in”
(1) A person who has suffered a motor accident injury as a result of a motor accident occurring outside New South Wales (whether before or after the commencement of this section) may be accepted as a lifetime participant in the Scheme if the person pays to the Authority, for payment into the Fund, a contribution determined by the Authority.
(2) The contribution is to be the amount that the Authority determines as the amount required to fund the treatment and care needs of the person as a lifetime participant in the Scheme in respect of the injury.
(3) A person is eligible to participate in the Scheme under this section only if the person would have been eligible to participate in the Scheme—
(a) had the motor accident occurred in New South Wales, and
(b) if the person has been awarded damages in respect of the injury—had those damages not been awarded.
(4) An application for a person to become a participant in the Scheme under this section cannot be made by an insurer.
(5) The LTCS Guidelines may make provision for or with respect to how a person’s contribution for participation in the Scheme under this section is to be determined.
s 7B: Ins 2017 No 10, Sch 5.10 [2].
8 Application for participation in the Scheme
8 Application for participation in the Scheme
8 Application for participation in the Scheme
(1) An application for a person to become a participant in the Scheme in respect of a motor accident injury is to be made to the Authority and can only be made by or on behalf of the person or by the insurer of a claim made by the person in respect of the injury.
(2) An application by an insurer does not require the consent of the person.
(3) The State Insurance Regulatory Authority may direct the insurer of a claim made by a person in respect of an injury to make an application for the person to become a participant in the Scheme, and the insurer must comply with such a direction.
(4) An application is to be made in the form approved by the Authority and is to set out or be accompanied by such particulars and information as may be required by the approved form.
(5) The Authority may require the injured person to provide authorisation for the Authority to obtain information and documents relevant to the motor accident injury from specified persons in connection with the application.
(6) The LTCS Guidelines may make provision for or with respect to applications to become a participant in the Scheme, including provision for or with respect to—
(a) the making and determination of applications (including the information required to be provided in connection with an application), and
(b) requiring an insurer to pay the costs of any assessment required by the LTCS Guidelines in connection with an application, and
(c) imposing restrictions on the time within which an application can be made or requiring the deferring of the making of an application until an injury has stabilised.
s 8: Am 2015 No 19, Sch 8 [3].
9 Acceptance as a participant
9 Acceptance as a participant
9 Acceptance as a participant
(1) A person becomes a participant in the Scheme if the Authority is satisfied that the person is eligible to be a participant and accepts the person in writing as a participant in the Scheme, either as a lifetime participant or an interim participant (according to the person’s eligibility).
(2) If the Authority is satisfied that a person is eligible to be a participant and that application for the person’s acceptance as a participant has been duly made, the Authority must accept the person as a lifetime participant or an interim participant (according to the person’s eligibility).
(3) A person accepted as an interim participant must be accepted as a lifetime participant if the Authority becomes satisfied during the person’s interim participation in the Scheme that the person is eligible for lifetime participation in the Scheme.
(4) A person accepted as a lifetime participant in the Scheme remains a participant for life.
(5) A person 3 years of age or over who is accepted as an interim participant remains an interim participant for a period of 2 years only.
(5A) A person under 3 years of age who is accepted as an interim participant remains an interim participant until the person is 5 years of age.
(5B) If a person who is an interim participant is accepted as a lifetime participant, the person ceases to be an interim participant on that acceptance and then remains a participant for life.
(6) A person cannot be accepted as an interim participant more than once in relation to the same motor accident injury.
(7) The expiration of a period of interim participation in the Scheme does not prevent subsequent acceptance of the person as a lifetime participant in the Scheme.
s 9: Am 2009 No 33, Sch 1 [4].
10
10 (Repealed)
10
s 10: Rep 2012 No 48, Sch 1 [5].
11 Effect of Scheme on motor accident compensation claims and limitation periods
11 Effect of Scheme on motor accident compensation claims and limitation periods
11 Effect of Scheme on motor accident compensation claims and limitation periods
(1) This Act does not limit or otherwise affect the application of the Motor Accidents Compensation Act 1999 in respect of a motor accident injury of a person who is or who is eligible to become a participant in the Scheme, except as specifically provided by that Act.
(2) While a person is an interim participant in the Scheme in respect of an injury, time does not run for the purposes of section 109 (Time limitations on commencement of court proceedings) of the Motor Accidents Compensation Act 1999 or a provision of the Limitation Act 1969 in respect of a cause of action on a claim for damages that relate to the injury or to any other injury suffered by the person as a result of the motor accident concerned.
Part 2A Payments under Scheme
Part 2A Payments under Scheme
Part 2A Payments under Scheme
pt 2A: Ins 2012 No 48, Sch 1 [6].
11A Assessed treatment and care needs of partici
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