Functional assessment and reasonable support
Can CTP pay for equipment or home modifications?
Potentially, when the item or modification is clinically justified and accident-related
A NSW CTP insurer can consider equipment and home modifications as treatment and care where they are reasonable and necessary in the circumstances and relate to the motor accident injury. A recommendation alone does not guarantee funding. The request should identify the functional problem, proposed item or work, alternatives considered, expected benefit, cost, ownership and review or maintenance implications.
Requests can range from short-term mobility or bathroom equipment to more substantial access changes. The evidence and approval process should be proportionate to the cost, risk and permanence of the proposal.
Do not purchase or commence building work before written approval unless urgent safety circumstances make that unavoidable and payment responsibility has been considered. Retrospective approval is not automatic.
Reviewed by Herman Chan, Stephen Young Lawyers
What assessment should support the request?
An occupational therapist or appropriate treating practitioner can assess the claimant in the actual environment. The statutory definition of treatment and care includes aids, appliances and modifications to a person’s home, transport, workplace or place of education, but section 3.24 still requires the claimed cost to be reasonable and the care to be reasonable, necessary and accident-related. The report should identify the task, current function, safety risk, equipment tried, measurements, cheaper or less intrusive alternatives and expected outcome.
For a substantial home modification, the file may require plans, photographs, ownership or tenancy information, builder quotations and coordination with other funding. The insurer needs to distinguish an accident-related requirement from ordinary renovation or a pre-existing accessibility need.
What issues arise with equipment?
The request should specify the model or functional specification, trial outcome, fitting or training, warranty, maintenance and expected duration. A high-cost item should not be chosen only because it is preferred if a safer and clinically equivalent lower-cost option exists.
Conversely, the cheapest item is not necessarily reasonable if it does not fit the claimant, home, injury or safety needs. Ask the assessor to explain why the selected option is appropriate rather than relying on a supplier quotation alone.
How are pre-existing disability and other funding handled?
Where the claimant already used disability support or equipment, compare the pre-accident baseline with the post-accident need. The CTP claim should address the additional requirement caused by the crash without duplicating another payer for the same item or service.
NDIS or other funding may require coordination, but its existence does not by itself decide the CTP insurer’s statutory responsibility. Provide both funding and clinical records so the issue can be assessed transparently.
Practical next steps
How to prepare an equipment or modification request
Start with function and safety, then identify the proportionate solution and evidence.
Define the functional problem
Identify the exact task, risk or barrier and how it changed because of the accident.
Obtain an appropriate assessment
Use an OT or relevant clinician who can assess the claimant and actual home environment.
Trial and compare options
Record why the proposed item works and why alternatives are unsuitable or insufficient.
Provide specifications and quotes
Include item details, installation, training, maintenance and any building or tenancy information.
Wait for written approval where practicable
Do not assume retrospective payment for a purchase or permanent work that was not approved.
Evidence
Equipment and modification evidence checklist
A strong request links the injury, task, environment, solution and cost.
- Diagnosis, prognosis and current functional restrictions.
- OT or treating assessment in the relevant environment.
- Photographs, measurements and description of the task or safety risk.
- Trial report and comparison of reasonable alternatives.
- Item specification, supplier quotation and maintenance information.
- Plans, builder quotes, ownership or landlord consent for modification work.
- Pre-accident equipment and funding records where relevant.
- Written insurer decision and any relied-on assessment.
Common problems
- A supplier quote does not replace an independent functional assessment.
- Do not describe an ordinary renovation as a medical necessity without task-specific evidence.
- Do not buy high-cost equipment before clarifying approval and payment responsibility.
- Avoid duplicate funding claims for the same item or period.
- The presence of pre-existing disability support does not eliminate a genuine accident-related increase.
Timing
Approval and dispute timing
Urgent discharge or safety needs should be identified clearly rather than hidden in an ordinary request.
- Protect the personal injury benefits claim within the general three-month period.
- Identify any hospital discharge, tenancy or safety date in the request and ask the insurer to confirm receipt.
- Guideline 4.106 ordinarily requires a written decision within 10 days after the insurer receives the complete treatment or care payment request.
- Do not commence permanent work based only on verbal discussions; obtain the written scope and decision.
- Check any refusal promptly for the stated internal-review and PIC rights applicable to that decision.
Frequently asked questions
- Can CTP pay for a wheelchair or mobility aid?
- Potentially where supported as reasonable, necessary and accident-related. A fitting, trial and functional specification may be required.
- Can I modify a rental property?
- Tenancy consent and practical alternatives must be addressed in addition to the clinical need and insurer approval.
- What if I already had similar equipment?
- Compare the pre-accident item and function with the new need. Replacement or upgrade is not automatic, but an accident-related change should be assessed.
- Will the insurer pay maintenance and repairs?
- The request and decision should address ongoing costs where relevant. Do not assume initial approval covers every future expense.
- Can family buy the item and seek reimbursement?
- Retrospective payment is not guaranteed. Clarify approval and ownership before purchase unless an urgent safety situation requires immediate action.
- Can a refusal go to PIC?
- Treatment and care disputes may be assessed through the applicable review and PIC process. Check the exact decision and current procedural requirements.
Related NSW CTP guides
Official sources
- Motor Accident Injuries Act 2017 (NSW), current in-force version
- SIRA Motor Accident Guidelines, current published version
- SIRA Motor Accident Guidelines Part 4: claims
- SIRA: fees and approval for motor crash health services
- SIRA: support services for people with an injury
- Personal Injury Commission: medical disputes
Assessment source: Motor Accident Injuries Act 2017 (NSW), section 3.24 and the current SIRA Motor Accident Guidelines Part 4. The insurer must apply the statutory test and current Guidelines to the individual treatment request and evidence.
Functional evidence review
Has equipment or a home modification been delayed or refused?
Send the assessment, quote and insurer decision. We can identify whether the dispute concerns accident causation, clinical need, alternatives, cost or another funding issue.
General information only: This page is general NSW CTP information, not legal or medical advice. It does not promise approval, reimbursement, a particular provider or a dispute outcome. Urgent medical care should not be delayed while waiting for legal advice.