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).
If you've suffered a disabling injury and need vehicle modifications to maintain mobility, the Personal Injury Commission (PIC) in New South Wales has specific expectations for claims. This article explains what evidence the PIC requires to support claims involving vehicle modifications, how rural location impacts dispute resolution, and how to meet SIRA guidelines. The PIC evaluates whether modifications are medically necessary and directly related to your injury, with particular scrutiny in rural areas where access to specialists may be limited.
NSW CTP Rules for Vehicle Modifications
Under the Motor Accident Injuries Act 2017, vehicle modifications such as hand controls, ramps, or mobility aids are considered 'treatment and care benefits' if they are medically necessary to address a threshold injury. The PIC requires evidence that the modification is:
- Directly related to your injury
- Prescribed by a medical practitioner
- Necessary for daily living
- Reasonable in cost and design
SIRA guidelines state that modifications must be 'reasonably necessary' and 'reasonably required' to maintain mobility. For example, a hand control system for a spinal injury would typically qualify, while a luxury mobility aid may not. Rural claimants must also demonstrate that the modification was not available through local healthcare providers.
Evidence Required for Modifications Claims
To support your claim, you must provide:
- A medical report confirming the injury and need for modifications
- A detailed description of the modification (e.g., type of hand control, wheelchair model)
- Evidence of medical necessity (e.g., doctor's notes, specialist reports)
- Proof of purchase or quotation for the modification
- A statement from your treating medical practitioner confirming the modification's necessity
In rural areas, the PIC may require additional documentation to verify that no local alternatives were available. For instance, if a rural clinic lacks a specialist to assess the modification, you may need to provide evidence of efforts to access alternative services.
How the PIC Assesses Modifications in Rural Disputes
The PIC evaluates modifications based on medical necessity, not convenience. In rural NSW, claimants may face unique challenges, such as limited access to specialists or higher transport costs. The PIC considers:
- Whether the modification was necessary due to geographic isolation
- Whether alternative solutions were explored
- Whether the modification improves mobility without unnecessary cost
A 2023 SIRA case example showed that a claimant in Dubbo was awarded hand controls after demonstrating that local clinics could not provide the necessary assessment. The PIC emphasized that rural claimants must 'show a clear link between the modification and the injury's impact on mobility.'
Dispute Resolution and Review Process
If your claim is disputed, you can request a review through the PIC's internal process. The PIC may:
- Request additional medical evidence
- Schedule a medical assessment
- Refer the matter to a medical expert
It's important to note that a challenge does not guarantee a changed decision. The PIC has discretion to uphold its original assessment if the evidence supports it. For rural claimants, delays in accessing specialists or documentation may require proactive steps to meet deadlines.
Practical Steps for Rural Claimants
- Secure medical documentation immediately after your injury, including reports from specialists
- Document the modification's cost and design with receipts and manufacturer details
- Keep records of any rural-specific challenges (e.g., transport delays, limited local services)
- Request a medical assessment if your claim is disputed
- Seek legal advice if you believe the PIC has misinterpreted your evidence
Time Limits and Next Steps
You have 52 weeks from the accident date to claim certain benefits under the Motor Accident Injuries Act 2017. However, disputes over modifications may require longer timelines, especially if medical assessments are needed. If you're unsure whether your claim meets the PIC's requirements, contact LegalAdvice.com.au for a free assessment of your circumstances.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.