What Home Modifications Are Covered Under NSW CTP Law?
If you have suffered a serious injury in a motor accident in New South Wales, you may be eligible for funding through the Compulsory Third Party (CTP) insurance scheme for home modifications. These changes are intended to make your home safer and more accessible following a permanent or long-term injury. Examples include installing ramps, widening doorways, modifying bathrooms for wheelchair access, or adding handrails. The Motor Accident Injuries Act 2017 (MAIA) and the Motor Accident Injuries Regulation 2017 set out the legal framework for these claims. The CTP insurer, or the insurer of the vehicle involved, must pay for reasonable and necessary modifications that are directly related to your injury and required to maintain your safety and independence at home.
How SIRA Determines Eligibility for Home Modifications
The State Insurance Regulatory Authority (SIRA) oversees the CTP scheme in NSW and provides guidance on what constitutes a valid claim for home modifications. To be eligible, the modification must be necessary because of a serious injury resulting from a motor accident. SIRA’s guidelines state that the injury must be serious, which under the MAIA means it must result in a whole person impairment (WPI) of at least 15%. This threshold is assessed by a qualified medical practitioner using the Motor Accident Guidelines.
SIRA will not approve a modification simply because it is convenient or desirable. The change must be directly linked to a functional limitation caused by your injury. For example, if you have lost the use of your legs due to a spinal cord injury, a ramp may be approved. If you have limited upper limb function and cannot reach a kitchen tap, a hand-held shower attachment may be approved. The insurer must consider whether the modification is reasonable, appropriate, and proportionate to the injury. SIRA’s assessment includes whether alternative solutions exist and whether the modification is cost-effective.
What Evidence Is Required to Support a Claim?
To support a claim for home modifications, you must provide clear and credible evidence. This includes:
- A medical report from a qualified practitioner confirming the nature and extent of your injury and its impact on your daily activities.
- A detailed assessment from an occupational therapist or a specialist in home accessibility (such as an architect or building consultant) outlining the specific modifications needed and why they are necessary.
- A written quote from a licensed builder or tradesperson for the work, including a breakdown of costs.
- Photographs of your current home setup, showing the barriers to access.
- A letter from your treating medical practitioner or case manager confirming that the modification is required for safety, independence, or to prevent further injury.
SIRA may also request a site inspection or independent assessment before approving funding. All documentation must be submitted through the insurer or via the SIRA online claims portal. Delays often occur when evidence is incomplete, inconsistent, or not submitted in a timely manner.
How SIRA’s Rules Differ from Other CTP Claim Types
Home modification claims differ from other CTP benefits in several key ways. Unlike treatment and care benefits or weekly income payments, which are generally limited to 52 weeks if only threshold injuries are present, home modifications are not subject to the same time limit. If a modification is necessary due to a serious injury, it may be approved regardless of how long it has been since the accident.
Additionally, home modifications are not automatically approved based on a diagnosis. They require a functional assessment showing that the modification is needed to maintain safety or independence. This contrasts with some treatment benefits, which may be approved based on a medical recommendation alone.
SIRA also applies a different standard for cost. While treatment benefits are assessed on medical necessity, home modifications are assessed on reasonableness and proportionality. A modification that is excessively expensive compared to a simpler alternative may be rejected, even if it is medically recommended.
Practical Steps and Time Limits
If you have suffered a serious injury and believe home modifications are necessary, you should act promptly. While there is no fixed deadline for submitting a claim for home modifications, delays in reporting the injury or providing evidence can affect the insurer’s ability to assess and approve the claim. It is advisable to notify your insurer as soon as possible after the accident, and to begin gathering evidence immediately.
A common mistake is to begin modifications before approval is granted. This can result in the insurer refusing to fund the work. Always seek written approval before any construction begins. If urgent safety concerns exist, you may apply for an interim payment, but this must be supported by medical evidence.
When to Seek Independent Advice
If your claim for home modifications is denied, or if you believe the insurer has not properly assessed your needs, you may request a review. SIRA provides a formal dispute resolution process for CTP claims. You may also seek advice from an independent legal or case management professional who understands the CTP system and SIRA’s guidelines.
A realistic example: A 42-year-old woman in Sydney was involved in a rear-end collision in February 2025. She sustained a spinal injury that resulted in a WPI of 22%. Her doctor confirmed she could no longer walk independently. An occupational therapist assessed her home and recommended a ramp and bathroom modifications. The insurer initially refused, citing cost, but after a review and submission of updated evidence, SIRA approved the modifications. The claim was processed under the MAIA and funded by the CTP insurer.
Next Steps
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.