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 Western Sydney seeking psychological treatment under NSW CTP claims, understanding the process is critical. Psychological treatment plans are a key part of CTP compensation, but they must be properly documented and submitted to SIRA. This article explains the early steps to request treatment, how SIRA guidelines apply, and legal boundaries to be aware of.
What You Can Claim Under NSW CTP
Under the Motor Accident Injuries Act 2017, injured road users can claim treatment and care benefits, including psychological support, if their injuries meet SIRA’s threshold criteria. SIRA’s guidelines define 'threshold injury' as a condition that requires treatment, such as anxiety or depression following a motor accident. For psychological treatment to be covered, a registered psychologist must provide a written treatment plan outlining the necessity of therapy, expected duration, and therapeutic goals.
Early Steps for Psychological Treatment Plans
- Seek Immediate Medical Attention: Visit a registered psychologist or psychiatrist within 28 days of the accident. Delaying treatment may affect eligibility for CTP benefits. Document all appointments and ensure your mental health professional records the link between the accident and your psychological condition.
- Obtain a Written Treatment Plan: Your psychologist must provide a detailed plan, including diagnosis, treatment goals, and frequency of sessions. This document must explicitly connect your injuries to the motor accident.
- Notify Your Insurer: Inform the at-fault driver’s CTP insurer (or SIRA if no at-fault driver is identified) about your treatment plan within 28 days. Delays beyond this period may jeopardise claims for weekly benefits or treatment costs.
- Keep Records of All Evidence: Retain copies of medical records, treatment plans, appointment confirmations, and any correspondence with insurers. These documents are essential for proving the necessity of psychological care under CTP rules.
SIRA Guidelines and Legal Boundaries
SIRA’s guidelines state that psychological treatment is only covered if it is 'reasonably necessary' and directly related to the accident. For example, a cyclist who suffered a whiplash injury and developed anxiety would qualify, but a pre-existing mental health condition unrelated to the accident would not. If your treatment is denied, you may need to seek independent medical opinion to challenge the decision.
Time Limits and Dispute Options
CTP claims must be submitted within 28 days of the accident, though some benefits (like weekly payments) have a 52-week limit for threshold injuries. If your treatment exceeds this period, you may need to reclassify your injury as a whole-person impairment (WPI) to access long-term support. Disputes over treatment eligibility should be resolved through SIRA’s review process or by seeking legal advice.
When to Seek Independent Advice
While SIRA provides clear guidelines, claims involving complex injuries or disputes often require legal assistance. A solicitor can help you navigate issues like contributory fault, overlapping workers’ compensation claims, or disputes over the necessity of psychological treatment. Always act promptly to preserve your rights under NSW CTP law.
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