What Is an OT Driving Assessment? A Complete Guide for NSW

An OT driving assessment is one of those things most people have never heard of until the day a doctor refers them for one. And when that happens, there's usually a lot of uncertainty, a bit of anxiety, and plenty of questions.

This is a full guide to what an OT driving assessment is, why they exist, who needs one, and what the whole process looks like in NSW.

What is an OT driving assessment?

An OT driving assessment (also called an Occupational Therapy driving assessment, a Fitness to Drive assessment, or a driving evaluation) is a formal evaluation of whether a person's medical condition is affecting their ability to drive safely.

It's the assessment approved by Transport for NSW for drivers with medical conditions that may impact their fitness to drive.

The assessment is conducted by a driver-trained occupational therapist, working alongside a specialist driving instructor for the on-road component.

Why do OT driving assessments exist?

Driving is one of the most complex everyday tasks we do. It requires good vision, physical ability, and a wide range of thinking skills (attention, processing speed, decision-making, spatial awareness), all working together in real time.

Many medical conditions can affect one or more of these skills, sometimes in ways that aren't obvious to the person themselves. A doctor can assess your medical status, but they can't observe you driving. That's where the OT comes in.

A driver-trained OT bridges the gap between the clinical assessment (which your doctor does) and the practical reality of being behind the wheel. The goal is to make sure that:

• Drivers with medical conditions can stay on the road safely for as long as possible

• The safety of other road users is protected

• Decisions about licensing are based on objective, clinical evidence, not just assumptions about age or diagnosis

Who is a driver-trained OT?

A driver-trained OT is an occupational therapist who has completed specific postgraduate training in assessing fitness to drive. In NSW, they must also be registered with Transport for NSW as a driver assessor.

This is a specialist qualification, not something every OT is trained in. The training covers the Austroads Guidelines (the national medical standards for driving), clinical assessment techniques, on-road assessment protocols, and report writing for Transport for NSW.

Who needs an OT driving assessment?

You may be referred for an OT driving assessment if you have a medical condition that could affect your driving. This is a broad category, and the specific conditions include (but aren't limited to):

Neurological conditions: stroke, Parkinson's disease, multiple sclerosis, epilepsy, brain tumour, dementia, brain injury, cerebral palsy.

Cognitive conditions: dementia, Alzheimer's disease, intellectual disability, autism spectrum disorder (typically for learner drivers), cognitive effects of mental health conditions.

Physical conditions: amputation, spinal cord injury, muscular dystrophy, significant arthritis, short stature, conditions affecting strength or coordination.

Sensory conditions: vision impairment, hearing loss (in some cases), sleep disorders.

Age-related factors: drivers over 75 in NSW are required to have an annual medical review to renew their licence, and may be referred for an OT assessment if concerns are identified.

Post-accident assessments: drivers recovering from a significant injury, particularly if the injury has affected their physical or cognitive function.

It's worth noting that having a condition on this list doesn't automatically mean you need an OT assessment. Your doctor makes the call about whether a referral is appropriate.

How does the referral process work?

The process usually starts with your doctor (GP, geriatrician, neurologist, rehabilitation specialist, or another treating doctor).

Step one: your doctor identifies that a medical condition may be affecting your driving.

Step two: your doctor completes the Transport for NSW Fitness to Drive form. On this form, the doctor indicates whether you can continue to drive, need an OT driving assessment, or should stop driving immediately.

Step three: if an OT assessment is needed, you or your doctor get in touch about a referral. Transport for NSW may also send you a letter requiring you to complete an assessment.

Step four: you contact an OT driving assessment service (such as Steer Driving) to book the assessment.

What happens during the assessment?

The assessment has two parts and usually takes 2 to 3 hours in total.

Part 1: The off-road (clinical) assessment

This part takes approximately 60 to 90 minutes. It can be conducted at your home (in the case of mobile services like Steer Driving) or at a clinic.

The OT will work through:

A clinical interview. A conversation about your medical history, your current symptoms, your medications, and your driving experience. If family members are present, they can contribute their observations.

Vision screening. Visual acuity (how clearly you see), visual fields (your peripheral vision), and other visual skills relevant to driving.

Cognitive assessment. Tools are used to assess the thinking skills most relevant to driving: attention, processing speed, decision-making, spatial awareness, and the ability to follow instructions.

Physical assessment. Strength, range of motion, coordination, reaction time, and fine motor control, particularly as they relate to operating a vehicle.

At the end of the off-road assessment, the OT discusses what they've found and explains what happens in the on-road component.

Part 2: The on-road assessment

You'll drive for approximately one hour with the OT and a specialist driving instructor in a dual-controlled vehicle. The drive happens in your local area, covering a mix of environments such as residential streets, main roads, intersections, roundabouts, and (where appropriate) motorway driving.

The OT observes how your medical condition affects your actual driving. This includes:

• Hazard perception and response

• Lane positioning and control

• Speed management

• Decision-making at intersections and in traffic

• Ability to follow road rules

• Response to unexpected situations

• Endurance over the course of the drive (particularly relevant for fatiguing conditions)

The OT isn't looking for perfect driving. Minor errors from nerves or unfamiliarity with the car are expected. What matters is whether your medical condition is causing consistent, safety-relevant issues.

What are the possible outcomes?

After the drive, the OT will discuss the results with you and your family (if present). The possible outcomes are:

Fit to drive with no restrictions. Your medical condition is not currently affecting your driving, and you can continue as normal.

Fit to drive with conditions. You can drive, but with restrictions. Common conditions include automatic transmission only, daytime driving only, within a specified radius of your home (for example, a 10 km radius), or with specified vehicle modifications.

Driving lessons recommended. If specific issues could be improved with targeted practice, the OT may recommend a set number of lessons with a rehabilitation driving instructor, followed by a reassessment.

Vehicle modifications recommended. If physical limitations affect your ability to operate the car, the OT may recommend equipment such as a steering knob, left-foot accelerator, or adapted controls. You'd then have lessons to learn to use the modifications before being reassessed.

Not fit to drive. If the effects of your medical condition are too significant for safe driving, the OT will recommend licence cancellation.

The OT then prepares a written report for Transport for NSW, your referring doctor, and you. Transport for NSW makes the final decision about your licence based on this report.

Can you appeal the outcome?

If Transport for NSW has cancelled your licence and you disagree with the decision, you have the right to appeal to the Local Court.

That said, if an OT has assessed you as not fit to drive, there's usually a clear clinical reason, and the best path forward is often to work with your doctor on rehabilitation or adjustment, rather than pursuing an appeal.

How much does it cost and what funding is available?

Costs vary between providers. Funding pathways depend on your situation:

NDIS may fund the assessment if driving supports your independence and community access goals.

iCare may cover the cost if your referral relates to a workplace injury or motor vehicle accident.

DVA may cover the cost for Department of Veterans' Affairs cardholders.

Medicare (CDM/EPC plan) may provide a rebate if your GP includes the assessment in a CDM plan.

Private payment is an option if none of the above apply.

Do I need reassessments?

It depends on the condition. Progressive or degenerative conditions (such as dementia or Parkinson's disease) typically require regular reassessment, often annually. Stable conditions may not require reassessment unless your situation changes.

Your doctor and OT will guide the reassessment schedule based on your individual circumstances.

How to start the process

If your doctor has referred you for an OT driving assessment in Sydney, you can start the process at steerdriving.com.au/referral.

If you haven't been referred yet but think you may need an assessment, the first step is to talk to your GP.

This article was written by Elise, an AHPRA-registered Occupational Therapist and Transport for NSW-registered driver assessor. Elise is the founder of Steer Driving, a mobile OT driving assessment practice in Sydney.

Frequently Asked Questions