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).
The 2017 reforms to NSW's Motor Accident Injuries Act introduced stricter rules for psychological treatment claims under the Compulsory Third Party (CTP) scheme. If you're in Armidale and seeking compensation for psychological injuries, understanding these changes is critical. The reforms now require claimants to provide structured treatment plans with clear clinical goals, evidence of treatment, and documentation showing the injury's impact. SIRA (State Insurance Regulatory Authority) evaluates these claims using the Motor Accident Guidelines, which emphasize objective evidence over general mental health diagnoses. This article explains the key changes, what evidence matters, and when to seek legal advice.
What Changed in 2017?
Before 2017, psychological injuries under CTP were often assessed using broad criteria, such as 'stress' or 'anxiety.' The reforms now require claimants to demonstrate a 'threshold injury' under the Motor Accident Guidelines, which includes specific neurological or psychological signs. For example, a claimant must show a spinal nerve-root injury with neurological signs or a diagnosed mental health condition with measurable impairment. SIRA now prioritizes structured treatment plans that include:
- A detailed treatment goal (e.g., 'reduce anxiety symptoms to pre-accident levels').
- Evidence of treatment (e.g., therapy records, psychologist reports).
- Documentation linking the injury to the accident.
This shift means general 'stress' claims are less likely to succeed unless they meet the new, stricter threshold.
What Evidence Matters?
To support a psychological treatment plan claim, you must provide:
- Medical records: Include diagnosis codes, treatment notes, and therapist reports.
- Treatment plan: A written plan from your mental health professional outlining goals and methods.
- Accident details: Evidence connecting the injury to the motor accident (e.g., police reports, witness statements).
- Impact evidence: Show how the injury affects your daily life (e.g., work absence, relationship strain).
SIRA may request these documents during a claim review. If your treatment plan lacks clear goals or evidence of injury, your claim could be denied.
Time Limits and Disputes
CTP claims must be submitted within 52 weeks of the accident if your injuries are classified as 'threshold injuries.' After this period, weekly benefits and treatment payments generally stop unless you have a 'whole person impairment' (WPI) of 10% or more. If your claim is disputed, SIRA will assess whether your treatment plan meets the Motor Accident Guidelines. You may need to provide additional evidence, such as a second opinion from a registered psychologist.
When to Seek Advice
If your claim is rejected or you're unsure whether your injury meets the new criteria, contact a solicitor specialising in NSW CTP claims. They can help you:
- Challenge a decision based on the Motor Accident Guidelines.
- Gather missing evidence (e.g., a structured treatment plan).
- Navigate SIRA's assessment process.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.
Example: A Claim That Succeeded
A claimant in Armidale suffered a whiplash injury and developed post-traumatic stress disorder (PTSD). Their psychologist provided a treatment plan with specific goals, such as 'reduce intrusive memories by 50% within 12 weeks.' The claimant also submitted therapy records and a report linking the PTSD to the accident. SIRA approved the claim because the treatment plan met the new evidentiary standards.
Next Steps
If your psychological injury claim was denied or you're unsure how to proceed, seek legal advice. A solicitor can help you understand your options under the current CTP scheme and ensure your claim meets SIRA's requirements.