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).
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 Balmain and need home modifications, understanding what evidence to collect is critical. Under NSW CTP laws, you must prove the necessity of modifications to claim compensation. This guide explains the evidence required, how to organize it, and how SIRA assesses such claims.
What Evidence Supports Home Modifications in CTP Claims?
To claim compensation for home modifications, you must provide evidence that the changes are medically necessary and directly related to your injury. Key documents include:
- Medical reports detailing your injury's impact on daily living (e.g., mobility restrictions, pain levels)
- Expert assessments from occupational therapists or physiotherapists confirming the need for modifications
- Cost estimates from approved contractors for ramps, handrails, or bathroom adaptations
- Before-and-after photos of your home to show the modification's purpose
- Doctor's notes linking your injury to the modification's necessity
SIRA evaluates whether the modifications are 'reasonably necessary' under the Motor Accident Guidelines. For example, a spinal injury requiring a ramp would qualify, while a minor sprain might not.
How to Organize Your Documentation
Systematically compiling evidence ensures your claim is processed efficiently. Create a file with:
- Accident details (date, location, insurer contact)
- Medical records (diagnoses, treatment plans, specialist reports)
- Modification plans (design sketches, contractor quotes, timelines)
- Witness statements from family or professionals confirming your injury's impact
- Correspondence with insurers or SIRA
Label each document with dates and relevance to your claim. For instance, if you need a wheelchair ramp, include a physiotherapist's note explaining how it enables independent living.
SIRA's Criteria for Assessing Modifications
SIRA uses the Motor Accident Guidelines to determine if modifications are 'reasonably necessary.' Key factors include:
- Medical necessity - Is the modification required to prevent harm or improve function?
- Proportionality - Are the costs reasonable for the injury's severity?
- Impact on daily living - Does the modification enable you to perform essential tasks (e.g., cooking, bathing)?
For example, a person with a traumatic brain injury requiring a stair lift would likely qualify, while a minor ankle sprain might not justify a permanent modification.
Time Limits and Dispute Resolution
You have 52 weeks from the accident date to claim benefits for threshold injuries. If your injury meets the 'threshold injury' criteria (per the Motor Accident Injuries Act 2017), benefits may be limited after this period. For serious injuries, you may still pursue claims beyond 52 weeks, but evidence must show ongoing necessity.
If your claim is disputed, you can request a review by SIRA or seek legal advice. Independent medical opinions may be required to challenge an insurer's decision.
When to Seek Legal Advice
Consult a solicitor if:
- Your insurer denies your claim without explanation
- You're unsure if your injury meets the threshold for modifications
- You need help navigating SIRA's assessment process
A lawyer can help you understand how to present your evidence and challenge decisions that affect your compensation.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.