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).
Under New South Wales' Compulsory Third Party (CTP) scheme, psychological treatment is covered as part of medical treatment costs. The State Insurance Regulatory Authority (SIRA) administers claims and funds treatment plans for mental health injuries, including therapy sessions, assessments, and prescribed interventions. Psychological injuries are treated as 'threshold injuries' under the Motor Accident Injuries Act 2017, meaning they are eligible for funding as long as they meet the clinical criteria outlined in the Motor Accident Guidelines. This includes conditions like post-traumatic stress disorder (PTSD), anxiety, depression, and other trauma-related disorders.
Documentation Required for Psychological Treatment Claims
To claim funding for psychological treatment, claimants must provide evidence of a clinically diagnosed mental health condition resulting from the motor accident. Key documentation includes:
- A detailed psychological treatment plan from a registered mental health professional
- Clinical records showing a direct link between the injury and the accident
- Proof of treatment costs, such as invoices for therapy sessions or prescribed medications
- A medical certificate confirming the necessity of the treatment
SIRA requires these documents to assess whether the treatment falls within the scope of the CTP scheme. For regional NSW residents, securing these records may involve additional steps, such as coordinating with rural-based practitioners or using telehealth services.
Regional NSW Considerations for Psychological Treatment Funding
In regional areas, access to mental health services can be limited, affecting both diagnosis and treatment. While SIRA guidelines apply uniformly across NSW, claimants in rural or remote locations may need to:
- Seek treatment from providers registered with the NSW Department of Health
- Use telehealth services approved by SIRA
- Account for travel time or additional costs when documenting treatment necessity
For example, a psychologist in regional NSW must demonstrate that the treatment plan addresses the specific psychological injury caused by the accident, not general mental health concerns.
Time Limits and Dispute Resolution
Claimants must submit their psychological treatment claims within 52 weeks of the accident, unless an extension is granted. If a claim is denied, SIRA provides a formal review process. Claimants can request a review by submitting additional evidence or seeking independent medical opinions. In cases of disagreement, disputing the decision requires a written application to SIRA within the specified timeframe.
Practical Example: Funding a Telehealth Session
Consider a scenario where a driver in regional NSW sustains a psychological injury after a collision. The claimant books a telehealth session with a psychologist registered with SIRA. The psychologist prepares a treatment plan detailing how the session addresses the trauma-related symptoms. The claimant submits the session invoice and the treatment plan to SIRA. If the claim is approved, the cost of the telehealth session is reimbursed under the CTP scheme.
Next Steps for Regional Claimants
If you are in regional NSW and seeking funding for psychological treatment under your CTP claim, ensure you:
- Obtain a detailed treatment plan from a registered mental health professional
- Submit all required documentation to SIRA within the 52-week period
- Consider telehealth options if local services are limited
- Seek independent advice if your claim is denied
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.