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).
If you've suffered a disabling injury in a motor vehicle accident and need vehicle modifications like hand controls or mobility aids, you may face disputes over the type, cost or necessity of these changes. In New South Wales, the Compulsory Third Party (CTP) scheme administered by SIRA determines what modifications are covered under your claim. This article explains how SIRA evaluates vehicle modification disputes, the legal framework governing these claims, and practical steps to resolve disagreements in the Newcastle and Hunter region.
How CTP Insurers Assess Vehicle Modifications
Under the Motor Accident Injuries Act 2017, CTP insurers must cover reasonable modifications that enable an injured person to maintain their mobility or independence. SIRA evaluates these claims based on medical evidence showing a direct link between the injury and the modification. For example, a pedestrian with a spinal injury may need hand controls to operate a car, while a cyclist with a lower limb injury may require a custom seat.
Insurers typically require:
- A medical report confirming the injury's severity and functional limitations
- Evidence that the modification improves mobility or independence
- Proof that the modification is 'reasonable' in cost and design
Disputes often arise when insurers question whether a modification is necessary or if it meets SIRA's standards. For instance, a claimant may argue that a specific type of hand control is essential for their daily activities, while the insurer may dispute its medical necessity.
Dispute Resolution Pathways for Vehicle Modifications
If your CTP claim for vehicle modifications is denied or disputed, you have several options to challenge the decision:
1. Internal Review by SIRA
You can request a review of the decision by SIRA's internal team. This process typically takes 30-60 days and may involve:
- Re-examining medical evidence
- Consulting with SIRA's medical advisors
- Considering new evidence submitted by the claimant
This pathway is ideal for resolving disputes without external intervention. However, it does not guarantee a change in the decision.
2. Personal Injury Commission (PIC) Medical Review
If the dispute involves medical assessments, you may request a medical review by the PIC. This process allows an independent medical expert to evaluate whether the modification is necessary. The PIC's decision is binding on SIRA.
3. External Review by the NSW Civil and Administrative Tribunal (NCAT)
For more complex disputes, you can apply to NCAT for a review of SIRA's decision. This process is more formal and may involve:
- Submitting additional evidence
- Having the claim reviewed by a tribunal member
- Receiving a binding decision
NCAT reviews are typically reserved for cases where the claimant believes SIRA has misinterpreted the law or failed to consider relevant evidence.
Practical Steps to Support Your Claim
To strengthen your CTP claim for vehicle modifications, gather the following evidence:
- Medical records showing the injury's impact on mobility
- Expert opinions from physiotherapists or occupational therapists
- Quotes or invoices for the modification (if applicable)
- Witness statements about how the modification improves your daily life
For example, if you need a custom seat for a wheelchair-accessible car, provide a medical report explaining why standard seats are unsuitable and how the modification enables you to drive safely.
Time Limits and When to Seek Advice
You have 52 weeks from the date of the accident to claim most benefits under the CTP scheme. However, disputes about vehicle modifications may require ongoing engagement with SIRA. If you receive a decision that you believe is unfair, seek legal advice promptly to explore your options.
Example of a Vehicle Modification Dispute
Consider a claimant who suffered a spinal injury in a car accident and requires a hand control system to drive. The insurer may dispute the claim by arguing that the modification does not meet SIRA's 'reasonable' standard. In this case, the claimant would need to provide:
- A medical report confirming the injury's impact on mobility
- Evidence that the hand control system is a standard modification for similar injuries
- Proof that the modification enables the claimant to drive safely
SIRA would then assess whether the modification meets its criteria, potentially leading to a revised decision.
Next Steps for Claimants in Newcastle and Hunter
If you're facing a dispute over vehicle modifications in your CTP claim, it's important to act quickly. SIRA's internal review process can take up to 60 days, and delays may affect your ability to access necessary modifications. For personalized guidance on dispute resolution options, complete the quick, no obligation enquiry form to request contact about your circumstances.