How SIRA Funds Psychological Treatment in NSW CTP Claims
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).
If you’ve suffered a psychological injury in a motor accident in NSW, you may be eligible for treatment costs to be funded through the Compulsory Third Party (CTP) scheme. The New South Wales Motor Accident Injuries Authority (SIRA) determines whether psychological treatment plans are covered under the scheme. This article explains how SIRA assesses funding for psychological care, what evidence is required, and how it differs from common law claims.
SIRA’s Role in Funding Psychological Treatment
Under the Motor Accident Injuries Act 2017, SIRA evaluates whether a treatment plan meets the criteria for funding. Psychological injuries, such as anxiety or post-traumatic stress disorder (PTSD), are eligible if they result from a motor accident. SIRA considers whether the treatment plan is:
- Medically necessary - Based on clinical evidence from a registered psychologist or psychiatrist.
- Reasonable and proportionate - Aligned with the Motor Accident Guidelines, which outline standard treatment protocols.
- Directly related to the accident - The injury must be a consequence of the motor accident, not a pre-existing condition.
SIRA does not cover treatment costs for injuries that fall below the 'threshold injury' definition, which includes soft tissue injuries like whiplash. Psychological injuries are typically assessed under the 'whole person impairment' framework, requiring a detailed treatment plan approved by a medical practitioner.
Evidence Required for Funding Psychological Treatment
To claim funding for psychological treatment, you’ll need to provide:
- A treatment plan from a registered psychologist or psychiatrist, detailing the type of therapy, duration, and expected outcomes.
- Medical records confirming the psychological injury is a direct result of the motor accident.
- Accident details such as police reports, witness statements, or medical certificates.
- Invoices or receipts for treatment costs, though SIRA may not cover all expenses if they exceed the scheme’s limits.
SIRA may request additional documentation to verify that the treatment plan aligns with the Motor Accident Guidelines. For example, a cognitive-behavioral therapy (CBT) plan for PTSD would need to show a clear link between the therapy and the injury.
How SIRA Guidelines Differ from Common Law Claims
Unlike common law claims, which may allow for damages for psychological injuries, the CTP scheme focuses on funding treatment rather than compensation for pain and suffering. This means:
- Common law claims may include damages for anxiety, depression, or PTSD, but these are separate from the CTP scheme.
- CTP funding is limited to medically necessary treatment costs, not general damages.
- SIRA’s role is to approve treatment plans, not to assess the extent of psychological harm.
This distinction is important because it affects how you pursue funding. If your psychological injury is not covered under the CTP scheme, you may need to explore common law claims or other benefits.
Example: Funding a Psychological Treatment Plan
Consider a scenario where a driver suffers a traumatic brain injury (TBI) in a car accident. A psychologist develops a treatment plan involving 12 weeks of cognitive therapy to address memory and concentration issues. SIRA would assess whether the treatment plan:
- Is medically necessary for a TBI-related condition.
- Aligns with the Motor Accident Guidelines for psychological care.
- Is directly related to the accident, not a pre-existing mental health condition.
If approved, SIRA would fund the treatment costs. However, if the injury is classified as a 'threshold injury' (e.g., a minor anxiety episode), funding may be limited or denied.
Time Limits and Dispute Resolution
You must notify SIRA of your claim within 52 weeks of the accident. If your claim is denied, you can request a review or escalate the matter to the NSW Civil and Administrative Tribunal (NCAT). It’s important to act quickly, as delays may affect your ability to fund treatment.
When to Seek Legal Advice
If you’re unsure whether your psychological injury is covered under the CTP scheme, or if SIRA has denied your claim, it’s advisable to consult a solicitor. They can help you understand your options and ensure you meet all requirements for funding.
Next Steps
Understanding how SIRA funds psychological treatment is crucial for claimants seeking support after a motor accident. By gathering the right evidence and following the correct process, you can increase your chances of securing funding for necessary care. Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.