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 NSW and are facing a dispute over your claim, understanding your options is critical. Under the Motor Accident Injuries Act 2017 (MAIA), disputes over psychological injuries in CTP claims are resolved through structured processes managed by the State Insurance Regulatory Authority (SIRA). This article explains how to challenge a decision, what evidence is needed, and time limits to act.
How SIRA Handles Psychological Injury Disputes
SIRA assesses all CTP claims, including psychological injuries, based on the Motor Accident Guidelines. If your claim is denied or the compensation offered is disputed, you can request a review. SIRA’s internal review process allows claimants to challenge decisions by submitting new evidence or clarifying existing information. For example, if your injury was initially assessed as a 'threshold injury' but you believe it meets the 'whole person impairment' standard, you can provide updated medical reports to support your case.
Evidence Required for Psychological Injury Claims
To dispute a decision, you must demonstrate that your psychological injury meets the legal criteria. Key evidence includes:
- Medical records showing a diagnosis of a mental health condition (e.g., PTSD, anxiety) linked to the accident
- A report from a registered medical practitioner detailing the injury’s impact on your daily life
- Evidence of ongoing treatment, such as therapy records or medication prescriptions
- Documentation of how the injury affects your ability to work, study, or perform personal care
SIRA may also consider expert opinions from neuropsychologists or psychiatrists to assess the injury’s severity.
Dispute Resolution Options and Time Limits
If your claim is rejected, you have 28 days to request an internal review with SIRA. If the review outcome is unsatisfactory, you may escalate the matter to the Personal Injury Commission (PIC) for a formal dispute resolution. The PIC can order an independent medical assessment if there’s a disagreement about the injury’s nature or severity. Note that time limits apply: you must notify SIRA of your dispute within 28 days of the decision, or your right to challenge it may expire.
Practical Steps for Claimants in Greater Sydney
- Review the decision letter from SIRA to understand the reason for the rejection.
- Gather additional evidence from your treating medical professionals.
- Submit a written request for an internal review within 28 days.
- Seek legal advice if the dispute escalates to the PIC, as this process can be complex.
When to Seek Independent Advice
Disputing a psychological injury claim often requires specialist knowledge of SIRA’s assessment criteria and the legal standards for 'threshold injuries' versus 'whole person impairment.' A solicitor experienced in CTP disputes can help you navigate the process, challenge incorrect assessments, and ensure your claim reflects your injury’s full impact.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.