Understanding Psychological Treatment Plans 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).
If you are a caregiver or family member in Bathurst supporting a person who has suffered a psychological injury in a motor accident, you may need to assist in preparing and submitting a psychological treatment plan under the NSW Compulsory Third Party (CTP) insurance scheme. This plan is a formal document that outlines the recommended psychological care, including therapy type, frequency, duration and expected outcomes. It must be developed by a qualified mental health professional and approved by the CTP insurer or the State Insurance Regulatory Authority (SIRA) to ensure it meets the scheme’s requirements.
The CTP scheme covers psychological injuries resulting from a motor accident, provided they are clinically diagnosed and linked to the accident. The treatment plan must reflect evidence-based care and be consistent with the Motor Accident Injuries Act 2017 and the Motor Accident Guidelines. Caregivers and family members play a supportive role in ensuring the claimant receives appropriate treatment, but they cannot independently author or approve a treatment plan.
What Documentation Supports a Psychological Treatment Plan?
To support a psychological treatment plan, the following documentation is typically required:
- A formal diagnosis of a psychological injury (such as post-traumatic stress disorder, depression or anxiety) from a registered medical practitioner or psychologist.
- A written treatment plan developed by a qualified mental health professional, including the type of therapy (e.g. cognitive behavioural therapy), session frequency, and estimated duration.
- Evidence of the injury’s connection to the motor accident, including a clinical history and assessment of symptom onset.
- Records of treatment progress, including session notes and outcome evaluations, to demonstrate ongoing need and effectiveness.
The CTP insurer may request additional evidence, such as a report from a treating practitioner or a psychological assessment conducted under SIRA’s guidelines. All documentation must be accurate, contemporaneous and reflect the claimant’s actual condition and treatment needs.
How Caregivers and Families Can Support the Process
As a caregiver or family member in Bathurst, your role is to assist the claimant in accessing and maintaining treatment, not to direct or author treatment plans. You can:
- Help the claimant keep appointments and maintain consistency with therapy.
- Gather and preserve medical records, correspondence with the insurer, and notes on changes in mental health or functioning.
- Confirm that the treating psychologist or psychiatrist is registered with the Psychology Board of Australia or the Australian Health Practitioner Regulation Agency (AHPRA), as required under SIRA’s standards.
- Provide information about the claimant’s daily functioning, such as changes in sleep, mood, concentration or ability to perform household tasks, to support the treatment plan’s validity.
It is important that you do not alter, fabricate or misrepresent medical evidence. Any attempt to falsify documentation may result in a claim being denied or subject to investigation.
SIRA’s Guidelines on Psychological Treatment Needs
SIRA’s Motor Accident Guidelines set out the criteria for assessing psychological treatment needs in motor accident claims. The guidelines state that treatment must be:
- Clinically appropriate and based on evidence-based practice.
- Reasonable and necessary in relation to the injury and the claimant’s recovery.
- Proportionate to the severity and impact of the psychological injury.
SIRA also requires that treatment plans include measurable goals and review points. For example, a plan may aim to reduce anxiety symptoms by 50% over 12 weeks, with review at 6 and 12 weeks. The insurer must approve the plan before treatment can be funded under the CTP scheme.
If the claimant has a pre-existing mental health condition, the insurer may assess whether the accident caused a significant deterioration. In such cases, a detailed clinical report from the treating practitioner is essential to establish the accident’s contribution to the current condition.
Legal Responsibilities and Limitations
Family members and caregivers have no legal authority to make claims on behalf of the injured person. The claimant must be the one to initiate and manage the claim, including providing consent for information sharing and treatment approval.
Caregivers are not legally responsible for the claimant’s treatment costs or for ensuring the treatment plan is approved. However, you may be asked to provide information to the insurer or a medical assessor, and you must respond truthfully and accurately.
You must not assume that a psychological injury automatically qualifies for ongoing treatment funding. The CTP scheme does not cover all psychological treatment indefinitely. Funding is subject to review and may be limited to a defined period, particularly if the injury is classified as a threshold injury under the Motor Accident Injuries Act 2017.
Time Limits and Dispute Resolution
There is no fixed deadline for submitting a psychological treatment plan, but it is best to submit it as soon as possible after treatment begins. Delays may affect the insurer’s ability to assess and approve funding.
If the insurer refuses to approve a treatment plan, you may request a review. You can also apply to SIRA for a review of the insurer’s decision. The review process may involve a medical assessor or an independent psychologist.
A common issue in Bathurst and elsewhere in NSW is that treatment plans are rejected because they lack detail, are not evidence-based, or fail to demonstrate a direct link to the motor accident. To avoid delays, ensure the plan includes:
- A clear description of the psychological injury.
- A rationale for the chosen treatment.
- A timeline with review points.
- Evidence of the claimant’s functional impairment due to the injury.
Hypothetical Example: Supporting a Family Member’s Treatment Plan
A 42-year-old woman in Bathurst was involved in a rear-end collision in February 2025. She developed severe anxiety and sleep disturbances following the accident. Her treating psychologist submitted a treatment plan for 16 weekly cognitive behavioural therapy sessions, supported by a clinical report showing a significant decline in functioning since the accident.
Her brother, a local tradesperson, helped her keep appointments and documented her progress, including her return to part-time work. He also preserved all correspondence with the CTP insurer and provided a written statement about her daily challenges. The insurer approved the plan after review, and treatment was funded under the CTP scheme.
This example illustrates how family support, accurate documentation and timely submission can help secure appropriate psychological treatment under the CTP scheme.
Next Steps for Caregivers and Families
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.