Home modifications, scheme eligibility basics (NSW-wide)
A threshold injury under the Motor Accident Injuries Act 2017 (NSW) includes a soft tissue injury and a psychological or psychiatric injury that is not a recognised psychiatric illness (adjustment disorder and acute stress disorder are the usual examples; s 1.6 and Motor Accident Guidelines Part 5).
If you've suffered a serious injury in a motor accident in NSW, you may be eligible for home modifications under the Compulsory Third Party (CTP) scheme. This article explains what types of modifications qualify, how to claim them, and the legal requirements.
NSW CTP rules for home modifications
Under the Motor Accident Injuries Act 2017 (MAIA), the CTP scheme covers treatment and care benefits, including home modifications, for eligible injuries. To qualify, the modification must be:
- Directly related to your injury (e.g., a ramp for a spinal injury or handrails for mobility issues)
- Necessary for daily living (e.g., a shower chair for a leg injury)
- Reasonable in cost (SIRA guidelines state modifications must be 'cost-effective' and 'not extravagant')
Serious injuries, such as those meeting the 'threshold injury' definition under MAIA s 3.11, typically qualify. Threshold injuries include fractures, dislocations, or nerve damage that significantly impact mobility or function.
Practical steps and evidence for home modifications
To claim home modifications, you'll need:
- Medical evidence, A doctor's report confirming your injury and the need for modifications. For example, a physiotherapist might recommend a ramp after a spinal injury.
- Modification details, Documentation showing the type of modification (e.g., a ramp, grab rails, or a shower chair) and its cost.
- Injury timeline, Proof the modification was needed within 52 weeks of the accident (the statutory period for weekly benefits under MAIA s 3.28).
Example: After a car accident causing a fractured pelvis, a claimant may need a raised toilet seat. A medical report confirming the injury and the modification's necessity would support the claim.
Time limits and dispute options
You must claim home modifications within 52 weeks of the accident if the injury is a threshold injury. For non-threshold injuries, there's no strict time limit, but delays may reduce your ability to prove the modification's necessity.
If your claim is disputed, you can:
- Request a review with SIRA (the Scheme Insurance and Risk Authority), which handles CTP claims.
- Appeal to NCAT (New South Wales Civil and Administrative Tribunal) if SIRA's decision is unsatisfactory.
When to seek legal advice
Speak to a solicitor if:
- Your insurer refuses to cover the modification
- You're unsure if your injury meets the threshold injury definition
- You need help preparing medical evidence
Next steps
CTP entitlements depend on the accident date, injury type, and claim timing. To discuss your circumstances, complete the quick, no obligation enquiry form.