Vehicle Modifications in CTP Claims: What the PIC Looks For in Disputes
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 require vehicle modifications like hand controls or mobility aids, the Personal Injury Commission (PIC) must assess whether these modifications are medically necessary and directly related to your injury. Disputes over such claims often hinge on the evidence provided and the PIC’s interpretation of the Motor Accident Injuries Act 2017. This article explains what the PIC expects when evaluating vehicle modifications in CTP claims on the Central Coast.
NSW CTP Rules Behind Vehicle Modification Claims
Under NSW’s Compulsory Third Party (CTP) scheme, claimants can seek benefits for injuries caused by motor vehicle accidents. Vehicle modifications, such as hand controls, ramps, or adaptive driving equipment, are considered under the ‘what you can claim’ provisions of the scheme. The PIC evaluates whether these modifications are:
- Medically necessary to address the injury’s impact on mobility or function.
- Directly related to the accident and not a pre-existing condition.
- Supported by evidence such as medical reports, specialist opinions, and documentation of the modification’s purpose.
SIRA’s guidelines state that modifications must be ‘reasonably necessary’ to enable the injured person to perform daily activities. For example, a cyclist with a spinal injury requiring a hand control to operate a car would qualify, but a modification for comfort rather than medical necessity might not.
Evidence to Avoid Disputes Over Vehicle Modifications
To prevent disputes, claimants must provide clear evidence linking the modification to the injury. Key documents include:
- Medical reports from a specialist confirming the injury’s impact on mobility.
- Photos or diagrams of the modification and its installation.
- Receipts or invoices showing the modification was purchased or installed.
- Witness statements or expert opinions supporting the modification’s necessity.
For instance, if a pedestrian requires a mobility aid after a leg injury, a doctor’s note detailing how the aid improves mobility is critical. Without such evidence, the PIC may dispute the claim.
Time Limits and Dispute Resolution
CTP claims must be submitted within 52 weeks of the accident, unless an extension is granted. For vehicle modifications, the PIC may require a review of the modification’s necessity within this timeframe. If a dispute arises, claimants can:
- Request an internal review with the PIC, which involves a medical expert assessing the modification’s relevance.
- Seek independent medical evidence to challenge the PIC’s decision.
It’s important to note that a dispute does not guarantee a change in the PIC’s decision. The burden of proof lies with the claimant to demonstrate the modification’s medical necessity.
When to Seek Legal Advice
If the PIC rejects your claim or disputes the necessity of your vehicle modification, it’s essential to consult a solicitor specialising in CTP claims. They can help:
- Challenge the PIC’s decision with additional evidence.
- Navigate the internal review process.
- Explore options for further dispute resolution.
Final Steps for Claimants
Vehicle modifications in CTP claims require meticulous documentation and a clear link to the injury. By following the PIC’s guidelines and providing robust evidence, claimants can strengthen their case. If you’re unsure about your options, complete the quick, no obligation enquiry form to request contact about your circumstances.