How SIRA Determines Psychiatric Injury Thresholds 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).
In New South Wales, the threshold for psychiatric injuries in Compulsory Third Party (CTP) claims is defined by the Motor Accident Injuries Act 2017 and the Motor Accident Guidelines. SIRA (State Insurance Regulatory Authority) evaluates whether a claimant has returned to daily activities by assessing functional recovery, not just the presence of a psychological condition. This process is critical for determining eligibility for benefits like weekly income payments or treatment and care benefits.
What SIRA Looks For in Daily Living Recovery
SIRA assesses whether a claimant can perform routine tasks such as managing household responsibilities, maintaining employment, or engaging in social activities. Key factors include:
- Medical evidence showing the ability to perform these tasks
- Statements from healthcare professionals about functional capacity
- Documentation of attempts to return to work or study
For example, a claimant who can cook meals, manage finances, and attend to personal hygiene may be deemed to have returned to daily activities, even if they continue therapy for anxiety.
Practical Steps for Claimants in Illawarra and South Coast
Claimants should:
- Keep detailed records of daily activities and challenges
- Obtain medical reports that explicitly address functional recovery
- Communicate regularly with their treating psychiatrist or psychologist
- Seek clarification from SIRA on how their specific circumstances fit the threshold criteria
Time Limits and Dispute Resolution
Benefits for threshold injuries are generally limited to 52 weeks under the Act. If a claimant's condition worsens or new symptoms emerge, they must notify SIRA immediately. Disputes over threshold injury assessments can be escalated to the NSW Civil and Administrative Tribunal (NCAT) for review.
When to Seek Legal Advice
Claimants should consult a solicitor if:
- They believe their injury exceeds the threshold injury definition
- They face pressure to 'return to daily activities' prematurely
- They need assistance navigating SIRA's assessment process
Next Steps for Claimants
Understanding the psychiatric injury threshold is essential for claimants in Illawarra and South Coast. While SIRA provides clear guidelines, the application of these rules can depend on individual circumstances. Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.