Understanding the Psychiatric Injury Threshold in NSW 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 determined by the Motor Accident Guidelines. These guidelines define what constitutes a 'threshold injury' under the Motor Accident Injuries Act 2017. Psychiatric injuries, such as post-traumatic stress disorder (PTSD) or anxiety, may qualify if they meet specific clinical criteria outlined in the guidelines. This article explains how to assess whether a psychiatric injury meets the threshold and provides practical examples to illustrate the process.
Key Legal Framework for Psychiatric Injuries
The NSW CTP scheme covers injuries that meet the threshold defined in the Motor Accident Guidelines. For psychiatric injuries, the guidelines require:
- Clinical evidence of a diagnosable condition (e.g., PTSD, adjustment disorder)
- A direct link between the injury and the motor accident
- Evidence that the injury is not a pre-existing condition
The threshold excludes minor issues like temporary anxiety or stress. For example, a person who develops PTSD after a serious car accident may qualify, but a person with pre-existing anxiety exacerbated by the accident would not meet the threshold.
Practical Examples of Threshold Injuries
Example 1: A pedestrian who witnessed a fatal collision and later developed PTSD with persistent flashbacks and avoidance behavior. Medical records show symptoms meeting DSM-5 criteria, and the injury is directly linked to the accident. This would likely meet the threshold.
Example 2: A cyclist who experienced brief anxiety after a minor collision but returned to normal within days. This does not meet the threshold as it lacks clinical severity and direct causation.
Steps to Take When Claiming a Psychiatric Injury
- Seek immediate medical attention: Document symptoms with a mental health professional.
- Obtain a clinical diagnosis: Ensure the injury is formally diagnosed and linked to the accident.
- Gather accident evidence: Include police reports, witness statements, and medical records.
- Notify your insurer: Contact the at-fault driver's CTP insurer to start the claim process.
Time Limits and When to Seek Advice
Claims must be made within 52 weeks of the accident for treatment and care benefits. If the injury is a threshold injury, weekly payments may be limited after 52 weeks. However, if the injury results in long-term impairment (e.g., 30% whole person impairment), you may still be eligible for ongoing compensation.
If you're unsure whether your injury meets the threshold, seek advice from a legal professional or the NSW Government's SIRA (Safety Insurance Regulatory Authority) for guidance.
Next Steps for Claimants
The available options depend on the facts of your case, including the date of the accident and the nature of your injury. Time limits and procedural requirements may apply. To request contact about your circumstances, complete the quick, no obligation enquiry form.