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’ve been injured in a motor accident in Greater Sydney and are receiving psychological treatment, you may be asked to develop or agree to a psychological treatment plan. This is a formal document that outlines the mental health care you are receiving or will receive as part of your Compulsory Third Party (CTP) insurance claim. It is not a separate legal claim, but a structured way to ensure your psychological injuries are managed under the CTP scheme and that treatment is funded appropriately.
Under the Motor Accident Injuries Act 2017 (MAIA), psychological injuries are recognised as valid and compensable injuries if they result from a motor accident. A psychological treatment plan helps ensure that treatment is clinically appropriate, evidence-based, and aligned with the goals of recovery and functional improvement. It is typically developed by a registered mental health professional, such as a psychologist or psychiatrist, and must be approved by your CTP insurer before treatment can be funded under the scheme.
What Questions Should Injured People Ask About Their Treatment Plan?
People in Greater Sydney often ask questions about how treatment plans are made, who controls them, and what happens if they disagree with the plan. Common questions include:
- Who is responsible for creating the psychological treatment plan?
- Can I choose my own psychologist or mental health provider?
- What happens if my insurer refuses to approve the plan or the treatment within it?
- How long will the treatment plan last, and can it be changed?
- Is the treatment plan the same as a claim for damages, or is it separate?
The CTP insurer has a duty to fund treatment that is clinically necessary and reasonable. You have the right to choose a mental health professional who is registered with the Psychology Board of Australia or the Australian Health Practitioner Regulation Agency (AHPRA). However, the insurer may only fund treatment provided by a registered provider, and the treatment must be consistent with the Motor Accident Guidelines.
What Must Be Included in a Psychological Treatment Plan?
A valid psychological treatment plan under NSW CTP must include:
- A clear diagnosis of the psychological injury, such as post-traumatic stress disorder (PTSD), depression, or anxiety, supported by clinical evidence.
- A description of the treatment approach, such as cognitive behavioural therapy (CBT), trauma-focused therapy, or medication management.
- A timeline for treatment, including the number of sessions and frequency.
- Measurable goals for recovery, such as improved mood, reduced avoidance behaviours, or return to work.
- A review date to assess progress and adjust the plan if needed.
The plan must be developed by a qualified mental health practitioner and submitted to your CTP insurer for approval. Insurers may request supporting medical evidence, including reports from your treating doctor or a psychological assessment, before approving the plan.
Evidence That Matters in CTP Claims Involving Psychological Treatment
To support your claim and ensure your treatment plan is approved, you should gather and preserve the following evidence:
- Medical records from your treating psychologist or psychiatrist, including assessment notes and progress reports.
- A copy of the completed psychological treatment plan, signed by your mental health provider.
- Evidence of how the motor accident caused or worsened your psychological injury, such as a statement from your treating doctor linking the injury to the accident.
- Records of any impact on your daily life, including work absences, inability to perform household tasks, or changes in relationships.
- Correspondence with your CTP insurer regarding the treatment plan, including any refusals or delays.
Photographs of the accident scene, witness contact details, and a police report (if available) may also help establish the context of the accident, particularly if there are disputes about the nature of the incident.
Time Limits and Dispute Options
There is no fixed time limit for submitting a psychological treatment plan, but you must notify your CTP insurer of your injury and treatment within a reasonable time. Delays in reporting may affect the insurer’s ability to assess your claim, particularly if you are seeking damages.
If your insurer refuses to approve a treatment plan, you have the right to request a review under the Motor Accident Injuries Act 2017. You may also seek an independent review through the State Insurance Regulatory Authority (SIRA) if the dispute involves a significant issue, such as the medical necessity of treatment or the insurer’s refusal to fund a provider you have chosen.
In Greater Sydney, many people seek a second opinion from a different mental health professional if they believe their treatment plan is not being properly managed. This is permitted under the scheme, but you must ensure the new provider is registered and submits a new plan to the insurer.
When to Seek Independent Legal Advice
A psychological treatment plan is not a substitute for legal advice. While SIRA provides guidance on what treatment is covered, it does not assess whether you have a valid claim for damages. If your psychological injury is severe or long-term, and you believe you may be entitled to damages, you should consult a solicitor who specialises in motor accident claims.
Common concerns include:
- Whether your injury qualifies as a threshold injury under the MAIA, which affects your ability to claim damages.
- Whether you are receiving adequate treatment and whether the insurer is acting reasonably.
- Whether you have a right to claim for future psychological care, including lifetime treatment.
A realistic example: A Sydney-based office worker was involved in a rear-end collision in the Eastern Suburbs. Following the accident, they developed severe anxiety and PTSD, which prevented them from returning to work. Their psychologist prepared a treatment plan for 12 months of CBT, including weekly sessions and monthly reviews. The CTP insurer initially delayed approval, citing a lack of supporting evidence. After the worker provided a detailed report from their treating doctor, the plan was approved. The worker later engaged a solicitor to assess their potential for damages, given the ongoing impact on their employment and mental health.
Next Steps
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.