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 in a motor vehicle accident in Greater Sydney, you may be eligible for treatment costs under the NSW Compulsory Third Party (CTP) scheme. This article explains how the scheme evaluates psychological treatment plans, what evidence is needed, and practical steps to claim support.
How the CTP Scheme Approves Psychological Treatment
The NSW CTP scheme covers treatment costs for injuries resulting from motor accidents, including psychological injuries. To qualify for a psychological treatment plan, your injury must meet specific criteria under the Motor Accident Injuries Act 2017.
- Eligibility for psychological treatment depends on whether your injury is classified as a
- threshold injury* or a
- whole person impairment*. Threshold injuries are defined as injuries that result in a
- neurological sign* or
- neurological symptom* that affects daily function. For psychological injuries, this could include symptoms like persistent anxiety, depression, or post-traumatic stress disorder (PTSD) that significantly impair your ability to work or live normally.
The scheme also considers whether your injury meets the spinal nerve-root qualification under the Motor Accident Guidelines. For example, a psychological injury might be linked to a spinal nerve injury that causes neurological signs, even if there’s no physical damage. This distinction is critical because it determines whether your treatment is eligible for funding.
Practical Steps to Claim Psychological Treatment Costs
To claim support for psychological treatment under the CTP scheme, you’ll need to provide evidence that your injury meets the scheme’s criteria. Key steps include:
- Obtain a medical report from a registered medical practitioner that clearly links your psychological injury to the motor accident. The report should specify whether your injury qualifies as a threshold injury or whole person impairment.
- Document your treatment plan. This includes details of therapy sessions, prescribed medications, and any other interventions. The treatment must be provided by a qualified mental health professional, such as a psychologist or psychiatrist.
- Submit a claim to SIRA (State Insurance Regulatory Authority). You’ll need to provide your medical records, accident details, and any other supporting evidence. SIRA will assess whether your injury meets the scheme’s eligibility criteria.
Time Limits and Dispute Options
The CTP scheme has strict time limits for claims. For injuries classified as threshold injuries, weekly benefits and treatment costs are generally limited to 52 weeks after the accident. If your injury is not a threshold injury, you may be eligible for longer-term support, but this depends on the severity of your condition.
If your claim is denied, you can request a review by SIRA or seek independent medical advice. In some cases, you may need to involve a legal professional to challenge a decision, especially if there’s a dispute over the classification of your injury.
Example: How a Psychological Injury Might Be Assessed
Consider a scenario where a pedestrian in Greater Sydney is involved in a motor accident and develops anxiety and sleep disturbances. A medical report would need to show that these symptoms are directly linked to the accident and that they meet the threshold injury criteria. If the report confirms this, the CTP scheme would cover the cost of therapy sessions and prescribed medications.
When to Seek Legal Advice
While the CTP scheme covers many psychological injuries, not all claims are straightforward. If your injury is complex or if your claim is denied, it’s important to seek legal advice. A solicitor can help you understand your options, challenge a decision, or ensure you receive all the support you’re entitled to.
Next Steps
The CTP scheme’s rules can be complex, especially when it comes to psychological injuries. To request contact about your circumstances, complete the quick, no obligation enquiry form.