Psychological Injury Claims in NSW CTP: Dispute Resolution Options
Where a person's only injuries resulting from the accident are threshold injuries, weekly benefits and treatment and care generally cease after 52 weeks (ss 3.11 and 3.28).
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).
If you've suffered a psychological injury after a car accident in Albury, NSW, you may face disputes over your claim under the Compulsory Third Party (CTP) scheme. This article explains your options for resolving such disputes, including SIRA's internal review process, mediation, and legal pathways.
How CTP Handles Psychological Injuries
Under the Motor Accident Injuries Act 2017, psychological injuries like anxiety, PTSD, or depression are covered as 'threshold injuries' if they meet specific medical criteria. SIRA (State Insurance Regulatory Authority) assesses claims based on the Motor Accident Guidelines, which require clinical evidence of a diagnosable condition. However, disputes can arise if your injury is not recognized, benefits are denied, or the claimant believes the assessment is incorrect.
Dispute Resolution Options
- Internal Review by SIRA
If your claim is rejected or you disagree with the outcome, you can request an internal review. SIRA will reassess your claim, considering new evidence or clarifying the original decision. This process is free and does not require legal representation.
- Mediation with the Personal Injury Commission (PIC)
If the dispute persists, you may seek mediation through the PIC. A neutral mediator will help both parties negotiate a resolution. This option is available if your claim involves a dispute over the extent of your injury or the appropriateness of benefits.
- Legal Action
As a last resort, you may pursue a legal claim through the NSW Civil and Administrative Tribunal (NCAT) or the Supreme Court. This requires a solicitor to file a case, and success depends on proving the claim meets the legal threshold.
Evidence Needed for Psychological Injury Claims
To support your claim, you must provide:
- Medical records confirming a diagnosis of a psychological injury
- Evidence of how the injury affects your daily life (e.g., work absence, therapy records)
- Accident details, including police reports or witness statements
- Proof of income loss or other consequences
SIRA may challenge claims lacking clinical evidence or where the injury does not meet the 'threshold injury' definition under the Motor Accident Guidelines.
Time Limits and Practical Steps
You have 52 weeks from the accident date to claim benefits for 'only injuries' (including psychological injuries). If your claim involves a dispute over the injury's severity, you must resolve it within this period. After 52 weeks, benefits for threshold injuries typically stop unless the injury is classified as a 'whole person impairment' (a more severe, long-term condition).
If your claim is denied, act quickly: SIRA's internal review must be requested within 28 days of the decision. For mediation, contact the PIC within 52 weeks of the accident.
Example: A Claimant's Dispute
Consider a claimant who suffered anxiety after a car accident. SIRA denied the claim, arguing the injury did not meet the 'threshold injury' criteria. The claimant requested an internal review, providing additional therapy records. SIRA revised its decision, approving benefits. This example shows how evidence and internal review can resolve disputes.
When to Seek Legal Advice
Disputes over psychological injury claims are complex. A solicitor can help you:
- Challenge SIRA's assessment of your injury
- Navigate the mediation process
- File a legal claim if necessary
However, legal action is costly and time-consuming. Most disputes are resolved through SIRA's internal review or mediation.
Next Steps
If your psychological injury claim is disputed, start by requesting an internal review with SIRA. Gather all medical and accident-related evidence to support your case. For complex disputes, consider consulting a solicitor who specializes in CTP claims.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.