How SIRA Assesses Psychiatric Injuries 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 injury claims under the Compulsory Third Party (CTP) scheme is determined by whether the injury meets the definition of a 'threshold injury' under the Motor Accident Injuries Act 2017. This requires a medical assessment to confirm that the injury is not minor and has resulted in a significant impact on the claimant’s daily activities. For regional NSW claimants, this assessment is conducted by the State Insurance Regulatory Authority (SIRA) based on clinical evidence and the Motor Accident Guidelines.
What SIRA Looks For in Daily Activity Assessments
SIRA evaluates whether a psychiatric injury has caused the claimant to be unable to perform ordinary daily activities, such as work, household tasks, or personal care. This is done by reviewing medical records, including reports from psychologists or psychiatrists, and assessing whether the injury meets the 'threshold injury' criteria. Key factors include:
- Clinical diagnosis: A confirmed psychiatric injury, such as depression, anxiety, or post-traumatic stress disorder (PTSD), must be documented.
- Impact on daily life: Evidence that the injury has significantly disrupted the claimant’s ability to function in their usual role or routine.
- Duration of impairment: The injury must have occurred as a direct result of the motor accident and persist beyond a short period.
For example, a claimant who was a nurse and is now unable to work due to PTSD caused by a car accident may qualify, while a claimant with mild anxiety that resolves within weeks may not meet the threshold.
Practical Steps for Regional NSW Claimants
Regional claimants should take the following steps to support their claim:
- Seek medical attention: Obtain a detailed report from a registered psychologist or psychiatrist confirming the psychiatric injury and its impact.
- Document daily activities: Keep a journal or log of how the injury affects routine tasks, such as cooking, cleaning, or commuting.
- Preserve accident details: Gather evidence like police reports, witness statements, and photographs of the scene.
- Contact SIRA directly: Regional claimants may need to request a face-to-face assessment or additional support due to limited access to specialist services.
Time Limits and When to Seek Advice
CTP claims must be made within a specific timeframe, typically within 12 months of the accident, though exceptions exist for certain injuries. If the claimant’s condition worsens or new evidence emerges, they may need to apply for a review. It is crucial to consult a legal professional if there are disputes over the assessment or if the claimant is unsure about their eligibility.
Next Steps for Claimants
Understanding the psychiatric injury threshold and how SIRA assesses daily activities is essential for regional NSW claimants. While the process can be complex, gathering accurate medical evidence and documenting the impact of the injury are critical. Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.