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).
Disputes over vehicle modifications in NSW Compulsory Third Party (CTP) claims are resolved through a structured process governed by the Motor Accident Injuries Act 2017 and SIRA guidelines. If you’ve been injured and require modifications like hand controls or vehicle aids, understanding your options is critical. This article explains how disputes are handled on the Central Coast, the evidence that matters, and when to seek legal advice.
How CTP Disputes Over Vehicle Modifications Are Handled
Under NSW law, vehicle modifications are considered part of your claim if they’re necessary due to a threshold injury. SIRA’s guidelines state that modifications must be 'reasonably necessary' and 'directly related' to your injury. Disputes often arise when insurers question the necessity, cost, or suitability of modifications.
For example, if you’ve sustained a spinal injury and require hand controls, the insurer may dispute whether the modification meets SIRA’s criteria. In such cases, the Motor Accident Injuries Act 2017 (s 4.4) limits weekly benefits after 52 weeks if only threshold injuries are involved, but modifications are treated separately as they fall under 'treatment and care benefits' (s 3.28).
SIRA Guidance for CTP Modification Claims
SIRA’s What you can claim page confirms that vehicle modifications are eligible if they’re 'reasonably necessary' for your recovery. This includes hand controls, ramps, and other aids that enable you to drive safely. However, the modification must be approved by a medical practitioner and documented in your treatment records.
On the Central Coast, claims are processed through SIRA’s Central Coast office, which follows the same national guidelines. If your insurer disputes the modification, SIRA may request additional evidence, such as:
- A medical report confirming the injury’s impact on mobility
- Proof of the modification’s cost and necessity
- Evidence that the modification aligns with SIRA’s
- Motor Accident Guidelines* (e.g., clinical signs of spinal nerve-root injury)
Dispute Resolution Options on the Central Coast
If your claim is disputed, you have several options:
1. Internal Review by SIRA
You can request an internal review of the decision by contacting SIRA’s Central Coast office. This process allows SIRA to reassess the claim based on new evidence or a reassessment of your medical condition. However, internal reviews do not guarantee a changed decision.
2. Medical Dispute Pathway
If there’s a disagreement about your injury’s severity or the need for modifications, you may seek a medical review through the Personal Injury Commission (PIC). The PIC can appoint an independent medical expert to assess your condition. This pathway is particularly relevant if your insurer disputes whether your injury meets the 'threshold injury' criteria.
3. External Review by the NSW Civil and Administrative Tribunal (NCAT)
If SIRA’s decision is unsatisfactory, you can apply to NCAT for a review. NCAT has the authority to overturn SIRA’s decision if it finds errors in the assessment. However, this process is time-sensitive and requires you to file within 28 days of the decision.
Practical Steps and Evidence to Gather
To strengthen your claim, collect the following:
- Medical records showing the injury’s impact on mobility
- Documentation of the modification’s cost and installation
- Witness statements or accident reports supporting your need for the modification
- Correspondence with your insurer detailing the dispute
For instance, if you’ve been denied a hand control modification, a medical report from your physiotherapist confirming your limited mobility will be crucial. SIRA may also require a statement from your treating doctor explaining how the modification will improve your quality of life.
Time Limits and When to Seek Advice
You have 52 weeks from the date of your injury to claim weekly benefits for threshold injuries. However, vehicle modifications are not subject to this time limit, as they are considered 'treatment and care benefits' under s 3.28. That said, delays in securing medical approval or insurer disputes can prolong the process.
If your claim is rejected or you’re unsure about your options, seek legal advice promptly. A solicitor can help you navigate SIRA’s processes, challenge disputes, and ensure your modifications are approved.
Example: A Cyclist’s Claim on the Central Coast
Consider a cyclist who suffered a spinal injury in a car accident. After 12 weeks of treatment, they require hand controls to drive. Their insurer disputes the modification, arguing it’s not 'reasonably necessary.' Under SIRA guidelines, the cyclist must provide:
- A medical report confirming the injury’s impact on mobility
- Evidence that the hand controls meet safety standards
- Proof of the modification’s cost
If the insurer rejects the claim, the cyclist can request an internal review, seek a medical reassessment, or escalate to NCAT.
Next Steps
Disputes over vehicle modifications in CTP claims require careful navigation of SIRA’s guidelines and the Central Coast’s specific processes. If your claim is denied or you’re facing a dispute, act quickly to preserve your rights. Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.