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).
When a vehicle modification contributes to an injury, NSW CTP insurers assess claims by determining whether the modification directly relates to the accident and injury. This process involves evaluating the modification’s role in the incident, its relevance to the injury, and whether it affects liability. In regional areas like Illawarra and South Coast, insurers may apply the same legal standards as metropolitan NSW but consider local practices when reviewing claims.
NSW CTP Rules for Modified Vehicle Claims
Under the Motor Accident Injuries Act 2017, CTP insurers must cover injuries caused by motor vehicles, including those involving modifications like hand controls or adaptive equipment. However, the insurer’s assessment focuses on whether the modification was a contributing factor to the injury. For example, if a driver with a spinal injury used a hand control modification that was not relevant to the accident, the insurer may limit compensation for that specific modification.
SIRA guidelines state that claims involving vehicle modifications must demonstrate a direct link between the modification and the injury. Insurers may request evidence such as medical reports, expert opinions, and documentation of the modification’s installation date. If the modification was installed after the accident, it may not be considered in the claim.
Practical Evidence for Modified Vehicle Claims
To support a claim, injured persons should gather:
- Medical records showing how the modification relates to the injury
- Evidence of the modification’s installation date and purpose
- Witness statements or accident reports detailing the modification’s role
- Documentation of any pre-existing conditions or modifications
For example, if a cyclist with a neck injury used a modified bike frame that contributed to the accident, the insurer would assess whether the modification directly caused or exacerbated the injury. In such cases, the claimant must prove the modification’s relevance to the incident.
Time Limits and Dispute Resolution
CTP claims must be submitted within 52 weeks of the accident, though extensions may apply for complex cases. If an insurer disputes a claim involving a modification, the claimant may need to provide additional evidence or seek a review under the NSW Civil and Administrative Tribunal (NCAT). Regional insurers in Illawarra and South Coast may have specific procedures for assessing modifications, so it’s important to contact the insurer directly for clarification.
When to Seek Legal Advice
If an insurer denies a claim or limits compensation for a modification, claimants should consult a solicitor to review the evidence and ensure all legal requirements are met. Legal professionals can help challenge an insurer’s decision if the modification was essential to the injury or if the insurer’s assessment is based on incorrect assumptions.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.