Changes to CTP Home Modification Claims After 2017 Reforms
Where a person's only injuries resulting from the accident are threshold injuries, weekly benefits and treatment and care generally cease after 52 weeks (ss 3.11 and 3.28).
The 2017 reforms to New South Wales’ Compulsory Third Party (CTP) motor accident compensation scheme introduced significant changes to how home modifications are assessed and approved for serious injury claimants. These reforms, implemented by the State Insurance Regulatory Authority (SIRA), now apply to all claims, including those in the Illawarra and South Coast regions. Key changes include stricter eligibility criteria, updated documentation requirements, and revised processes for challenging denied claims.
Key Reforms Affecting Home Modifications
Under the revised Motor Accident Injuries Act 2017, home modifications are no longer automatically approved for all serious injuries. Instead, claimants must demonstrate that the modification is reasonably necessary to maintain independence or prevent further harm. SIRA now applies a stricter threshold, requiring evidence that the modification directly addresses a specific functional limitation caused by the injury.
For example, a claimant who suffered a spinal injury may need a ramp installed, but a simple handrail might not qualify if it does not address mobility restrictions. The reforms also clarify that modifications must be reasonably necessary at the time of the claim, not just at the time of the injury.
How SIRA Assesses Eligibility
- SIRA evaluates home modification claims based on the
- Motor Accident Guidelines* and the
- Motor Accident Injuries Act 2017*. Claimants must provide:
- Medical evidence confirming a permanent functional limitation (e.g., a doctor’s report detailing mobility issues)
- Specific details about the proposed modification (e.g., a quote for a ramp, a diagram of the home)
- Evidence of necessity (e.g., a statement explaining how the modification enables daily tasks)
SIRA also considers whether the modification is cost-effective and whether alternative solutions (e.g., mobility aids) could achieve the same outcome.
Practical Steps for Claimants
To support a home modification claim, injured persons should:
- Consult a medical practitioner to document functional limitations
- Get quotes or cost estimates for the proposed modification
- Provide a detailed plan showing how the modification addresses the injury’s impact
- Submit all evidence to SIRA within 52 weeks of the accident, as benefits for threshold injuries typically stop after this period
Claimants should also note that SIRA may request independent medical assessments to verify the necessity of the modification.
Regional Considerations for Illawarra and South Coast
While the 2017 reforms apply statewide, claimants in the Illawarra and South Coast regions should be aware of:
- Local building codes that may affect the approval of certain modifications
- Higher costs for modifications in remote areas due to limited service providers
- Unique accessibility challenges in hilly or coastal regions that may require specialized equipment
Claimants should contact SIRA directly to confirm whether their specific location affects eligibility.
Disputing a Denied Claim
If SIRA denies a home modification claim, claimants can:
- Request a review by submitting additional evidence
- Appeal to the NSW Civil and Administrative Tribunal (NCAT) within 28 days of the decision
- Seek legal advice to challenge the decision on grounds such as procedural errors or misinterpretation of medical evidence
When to Seek Legal Advice
Claimants should consult a solicitor if:
- Their claim is denied and they are unsure how to appeal
- They face pressure to settle for less than the value of the modification
- They need help navigating SIRA’s complex application process
A solicitor can also help ensure that all evidence is submitted correctly and that the claimant’s rights under the 2017 reforms are protected.
Conclusion
The 2017 CTP reforms have significantly changed how home modifications are assessed in NSW, including for claimants in the Illawarra and South Coast. While the process is more rigorous, claimants who understand the new criteria and prepare thorough evidence have a stronger case. If you are unsure how these reforms apply to your situation, complete the quick, no obligation enquiry form to request contact about your circumstances.