How SIRA Assesses Vehicle Modifications in CTP Claims
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 been injured in a motor vehicle accident and need modifications like hand controls or vehicle aids, the NSW government's State Insurance Regulatory Authority (SIRA) determines whether these changes are covered under your Compulsory Third Party (CTP) claim. SIRA evaluates whether the modification is essential to your recovery and whether it aligns with the injury's impact on your daily life.
SIRA's rules are clear: modifications must be directly related to your injury and necessary for your safety or mobility. For example, if your injury has left you unable to operate a standard vehicle, a hand control system may be approved. However, SIRA will also consider whether the modification is cost-effective and whether alternative solutions could achieve the same outcome.
Legal Framework for Vehicle Modifications in CTP Claims
Under the Motor Accident Injuries Act 2017, CTP claims cover 'treatment and care benefits' and 'weekly income benefits' for injuries resulting from motor vehicle accidents. Vehicle modifications are considered part of 'treatment and care' if they are essential to your recovery.
SIRA's guidelines state that modifications must be 'reasonably necessary' and 'directly related' to your injury. For instance, if your injury has caused a loss of mobility, a vehicle modification that enables you to drive safely may be approved. However, SIRA will also assess whether the modification is 'reasonably necessary' and whether it aligns with your long-term recovery plan.
Practical Steps and Evidence for Vehicle Modifications Claims
To support your claim for vehicle modifications, you'll need to provide:
- Medical evidence confirming your injury's impact on your mobility or safety
- Documentation of the modification (e.g., a quote from a specialist installer)
- Proof that the modification is essential to your recovery
- Evidence that alternative solutions are not viable
SIRA may also request a medical report from your treating practitioner to confirm the modification's necessity. It's important to ensure all evidence is clear and directly links the modification to your injury.
Time Limits and Dispute Options
CTP claims must be made within 52 weeks of the accident date, unless an extension is granted. If your injury is classified as a 'threshold injury' (a minor injury under the Motor Accident Guidelines), benefits may stop after 52 weeks. However, vehicle modifications may still be approved if they are essential to your recovery.
If SIRA denies your claim, you can request a review by submitting a written objection. You may also seek independent legal advice to challenge the decision. SIRA's review process considers whether the original assessment was based on accurate information and whether the modification meets the legal criteria.
Example: How SIRA Might Assess a Hand Control Claim
Imagine a driver who suffered a spinal injury in a car accident. After treatment, they require hand controls to drive safely. SIRA would assess whether the injury has caused a loss of mobility that necessitates the modification. They would also consider whether the modification is 'reasonably necessary' and whether alternative solutions (e.g., a different type of vehicle) could achieve the same outcome.
In this case, SIRA would likely approve the hand controls if the injury has significantly impaired the driver's ability to operate a standard vehicle. However, if the injury is minor and the modification is not essential, SIRA may deny the claim.
When to Seek Legal Advice
If you're unsure whether your vehicle modification qualifies for coverage, or if your claim has been denied, it's important to seek legal advice. A solicitor can help you understand your options and ensure your claim meets SIRA's requirements.
Next Steps
CTP claims involving vehicle modifications depend on the specifics of your injury and the modification's necessity. To request contact about your circumstances, complete the quick, no obligation enquiry form.