This article continues our series on motor accident compensation in NSW. You can read about other matters of particular relevance to NSW Trustee and Guardian (NSWTG) clients in part 7 found here.

In previous parts of this series, I briefly mentioned the Lifetime Care and Support Scheme which is of particular relevance to seriously injured protected persons under management. The scheme pays for treatment, rehabilitation and care for people who have been injured in a motor accident in NSW. There are similar schemes in other jurisdictions.

It is a no-fault scheme. Benefits are payable to injured persons, regardless of who was at fault, provided the injury meets the eligibility criteria. In the case of children, the motor accident must have occurred after 1 October 2006 and, in the case of adults, after 1 October 2007.

Severe injuries that may be eligible for the Scheme include:

  • Spinal cord injury
  • Brain injury
  • Complications
  • Burns
  • Permanent blindness

As part of the application process, a medical specialist will need to complete a medical certificate to confirm the severity of your injury. There may also be some specific assessments for the particular type of injury to help determine if it will meet the eligibility criteria. These will usually be completed by the treating team.

Below are the assessment tools that are used for each type of injury that may be eligible for the Scheme:

  • Brain injuries and burns: FIM™ and WeeFIM®.
  • Spinal cord injuries: American Spinal Injury Association (ASIA) Scale.
  • Amputations: no additional assessment tool, determined by the percentage loss of limb/s or assessment of equivalent impairment.
  • Permanent Blindness: no additional assessment tool, they must be legally blind in both eyes.

 

Brain Injuries

The Lifetime Care and Support Guidelines define a traumatic brain injury as an insult to the brain, usually with an associated diminished or altered state of consciousness that results in permanent impairments of cognitive, physical and/or psychosocial functions. A person may be eligible for the Scheme if they have sustained a traumatic brain injury and:

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

 

Burns

A person may be eligible for the Scheme if they have sustained burns and:

  • the burns were caused by the motor accident; and
  • they have full thickness burns greater than 40 per cent of their total body surface area, or greater than 30 per cent of their total body surface area if you are a child under 16 years; or
  • they have inhalation burns that have caused long term respiratory impairment; or
  • they have full thickness burns to the hand, face or genital area; and
  • one of the following criteria is met:
    • if over 8 years of age: a score of 5 or less on any of the items on the FIM™ or WeeFIM® due to the burns; or
    • if aged from 3 to 8: a score two less than the age norm on any item on the WeeFIM® due to the burns; or
    • if aged under 3 years: a medical certificate from a paediatrician or an appropriately qualified medical specialist otherwise approved in writing by us that states they will probably have permanent impairment due to the burns resulting in a significant adverse impact on your normal development.

 

Spinal Cord Injuries

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

A person may be eligible for the Scheme if they have sustained a spinal cord injury and if:

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

 

Amputations

A person may be eligible for the Scheme if they have had an amputation or amputations, or the equivalent impairment, caused by the motor accident that meet/s the criteria described below:

 

Criteria for Multiple Amputations

The injury resulting in the amputations, or the equivalent impairment, was caused by the motor accident; and

They have multiple amputations of the upper and/or lower extremities (or equivalent impairment or some combination), meaning that there is more than one of the following types of amputation at or above the level of:

  • a “short” transtibial or standard transtibial amputation, as defined by the loss of 50 per cent or more of the length of the tibia. This includes all other amputations of the lower extremity (such as knee disarticulation or transfemoral amputation) above this level;
  • a thumb and index finger of the same hand, at or above the first metacarpophalangeal joint. This includes all other amputations of the upper extremity (such as below-elbow or above elbow amputation) above this level;
  • there are multiple impairments, each of which is an ‘equivalent impairment’ to one of the types of amputation above. ‘Equivalent impairment’ means the functional equivalent to an amputation, resulting from an injury such as (but not limited to) brachial plexus avulsion or rupture, where paralysis exists and movement in the paralysed limb, or relevant part thereof, is minimal or non­existent due to the injury.

 

Criteria for Unilateral Amputation

  • The injury resulting in the amputation (whether amputation, or an equivalent impairment), was caused by the motor accident; and
  • They have one of the following:
    • forequarter amputation (complete amputation of the humerus, scapula and clavicle) or shoulder disarticulation;
    • hindquarter amputation (hemipelvectomy by trans-section at sacroiliac joint, or partial pelvectomy);
    • hip disarticulation (complete amputation of the femur); or
    • an equivalent impairment to one of the types of amputation above. ‘Equivalent impairment’ means the functional equivalent to an amputation, resulting from an injury such as (but not limited to) brachial plexus avulsion or rupture, where paralysis exists and movement in the paralysed limb, or relevant part thereof, is minimal or non-existent due to the injury.

 

Permanent Blindness

A person may be eligible for the Scheme if they lost sight in both eyes and:

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

 

Read more about Motor Accident Compensation in NSW in part 9 of the series, “Representing a Person Under Management”.