Psychological Treatment Plans and CTP Claims in NSW
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 injured in a motor vehicle accident in Albury and seeking compensation, documenting your psychological treatment is critical. Under NSW's Compulsory Third Party (CTP) scheme, psychological injuries must be supported by a structured treatment plan to qualify for benefits. This article explains how to prepare your treatment documentation, what insurers look for, and steps to take if your claim is disputed.
How SIRA Assesses Psychological Treatment Plans
The State Insurance Regulatory Authority (SIRA) oversees CTP claims in NSW. For psychological injuries, SIRA requires a treatment plan that demonstrates a clear connection between your injury and the treatment. This includes:
- A diagnosis of a psychological condition (e.g., post-traumatic stress disorder, anxiety)
- Specific treatment goals (e.g., reducing panic attacks, improving sleep)
- A schedule of therapy sessions or other interventions
- Evidence of how the treatment addresses your symptoms
Insurers will scrutinise whether the treatment plan aligns with standard clinical practices. For example, a therapist's notes must show how each session addresses your specific symptoms and progress.
Evidence Needed for Psychological Claims
To support your claim, gather:
- Medical records: Include diagnosis codes (e.g., ICD-10-AM) and therapist notes
- Accident details: Police reports, witness statements, and photos of the scene
- Income records: Proof of lost wages or reduced earning capacity
- Treatment records: Attendance logs, therapy notes, and medication records
- Expert reports: If your injury meets the 'threshold injury' criteria under the Motor Accident Injuries Act 2017
A key requirement is showing that your psychological injury resulted directly from the accident. For instance, if you developed anxiety after a collision, your therapist must link your symptoms to the incident.
Practical Steps for Albury Claimants
- Seek immediate treatment: Visit a registered psychologist or psychiatrist within 28 days of the accident to establish a treatment timeline
- Request a formal treatment plan: Ask your therapist to document your diagnosis, treatment goals, and expected duration
- Keep all records: Store copies of medical records, therapy notes, and correspondence with insurers
- Notify your insurer: Submit your claim within 52 weeks of the accident to avoid losing benefits for threshold injuries
- Review your claim: If your insurer disputes your treatment plan, request a detailed explanation of their concerns
What to Do If Your Claim is Disputed
If your insurer rejects your psychological treatment plan, you may:
- Request a review of their decision within 28 days
- Seek an independent medical opinion
- Apply for a review by the NSW Civil and Administrative Tribunal (NCAT)
Remember, the 52-week limit applies only to 'threshold injuries' - if your injury exceeds this threshold, you may still be eligible for ongoing benefits.
When to Seek Legal Advice
Consult a solicitor if:
- Your insurer refuses to pay for psychological treatment
- You're unsure if your injury meets the threshold injury criteria
- You need help appealing a decision
A lawyer can help you understand whether your claim falls under the Motor Accident Injuries Act 2017 or requires a common law damages claim.
Next Steps
CTP claims depend on accurate documentation and timely action. If you're in Albury and need help preparing your psychological treatment plan, complete the quick, no obligation enquiry form to request contact about your circumstances.