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're an injured road user in Armidale seeking psychological treatment under NSW's Compulsory Third Party (CTP) scheme, understanding the early steps is critical. The CTP scheme covers treatment for injuries, including psychological conditions, but requires specific documentation and timely action. This article explains how to request psychological treatment plans, how SIRA evaluates claims, and what evidence is needed to support your case.
What You Can Claim Under NSW CTP
Under the Motor Accident Injuries Act 2017, injured road users can claim treatment for psychological injuries, such as anxiety or post-traumatic stress, if they meet the 'threshold injury' criteria. SIRA (State Insurance Regulatory Authority) administers these claims and evaluates whether a psychological treatment plan is necessary. This includes therapy sessions, psychiatric assessments, and other evidence-based interventions. To qualify, the injury must result from a motor vehicle accident and meet the clinical guidelines outlined in the Motor Accident Guidelines.
Early Steps for Psychological Treatment Claims
- Seek Immediate Medical Attention: Visit a registered medical practitioner or psychologist to document your psychological symptoms. A formal treatment plan from a qualified professional is essential. This should include details like diagnosis, treatment goals, and expected duration.
- Preserve Accident Evidence: Gather records of the accident, such as police reports, witness statements, and photographs. These help establish the link between the incident and your psychological injury.
- Notify Your Insurer: Contact the at-fault driver’s CTP insurer within the required timeframe. SIRA typically requires claims to be submitted within 52 weeks of the accident, though exceptions exist for complex cases.
- Submit a Treatment Plan: Provide the insurer with your psychologist’s treatment plan, including clinical notes and a statement of how the treatment addresses your injury. SIRA may request additional documentation, such as a letter from your doctor confirming the need for therapy.
How SIRA Assesses Psychological Claims
SIRA evaluates claims based on the Motor Accident Guidelines, which define 'threshold injury' as a condition that significantly impacts daily life. For psychological injuries, this often includes symptoms like persistent anxiety, sleep disturbances, or difficulty concentrating. SIRA may also consider the 'whole person impairment' rating, which assesses how the injury affects your physical and mental capacity. If your claim is denied, you can request a review or seek independent medical advice.
Time Limits and Dispute Options
Claims must generally be submitted within 52 weeks of the accident. If you wait beyond this period, SIRA may refuse the claim unless there are exceptional circumstances. If your insurer disputes your treatment plan, you can:
- Request a review of the decision
- Seek a second opinion from a registered medical practitioner
- Lodge a formal complaint with SIRA
Example Scenario
Consider a cyclist in Armidale who suffered a traumatic brain injury in a collision. Their doctor recommends cognitive therapy to address memory and concentration issues. The cyclist submits the treatment plan to their insurer, who initially denies the claim. After providing additional evidence, including a psychologist’s report, the claim is approved. This highlights the importance of thorough documentation and timely action.
When to Seek Legal Advice
While SIRA handles most claims, complex cases, such as disputes over fault or overlapping workers’ compensation claims, may require legal assistance. A solicitor can help navigate procedural hurdles and ensure your rights under the CTP scheme are protected.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.