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 preparing a psychological treatment plan for a NSW Compulsory Third Party (CTP) claim following a motor accident, understanding the legal and medical requirements is essential. This article explains what evidence is needed, how SIRA evaluates psychological claims, and practical steps to prepare for medical assessments in Albury NSW.
What Evidence is Needed for a Psychological Treatment Plan?
Under NSW CTP laws, a psychological treatment plan must demonstrate a connection between your injury and the motor accident. Key evidence includes:
- A detailed medical report from a registered psychologist or psychiatrist
- Documentation of symptoms matching the Motor Accident Guidelines (MAG) criteria
- Records of treatment sessions, including therapy notes and progress reports
- Evidence of how the injury impacts daily life, work, or relationships
SIRA requires treatment plans to show a 'threshold injury', a defined level of psychological impairment under the MAG. This typically involves clinical signs like persistent anxiety, depression, or post-traumatic stress symptoms that affect functioning.
How SIRA Evaluates Psychological Claims
SIRA assesses psychological claims based on the Motor Accident Guidelines, which outline specific clinical signs for different impairment levels. For example:
- Mild impairment: Symptoms that interfere with daily activities but not work
- Moderate impairment: Symptoms that reduce work capacity by 20-50%
- Severe impairment: Symptoms that prevent work or require significant support
Medical assessments must be conducted by SIRA-approved practitioners. If your treatment plan doesn't meet the MAG criteria, SIRA may reject the claim or limit benefits. It's crucial to ensure your psychologist documents how your symptoms align with the guidelines.
Practical Steps for Preparing for Medical Assessments
- Consult your treating psychologist to ensure your treatment plan meets SIRA's requirements. Ask them to specify how your symptoms match the MAG.
- Prepare a timeline of symptoms, including when they began, how they've progressed, and how they affect your daily life.
- Gather all medical records related to your treatment, including diagnostic tests, therapy notes, and medication records.
- Document work or study impacts with employer statements, academic records, or attendance records.
- Review your claim with a CTP specialist before the 52-week statutory limit for treatment benefits, as SIRA may stop weekly payments after this period unless you meet higher impairment thresholds.
Time Limits and Dispute Options
You have 52 weeks from the accident date to claim treatment and weekly income benefits under the Motor Accident Injuries Act 2017. After this period, SIRA may stop benefits unless your impairment meets higher thresholds. If your claim is disputed, you can:
- Request a review by SIRA's Medical Advisory Committee
- Seek independent medical opinions
- Appeal to the NSW Civil and Administrative Tribunal (NCAT)
When to Seek Legal Advice
If your psychological injury is complex, or if SIRA disputes your claim, it's important to consult a solicitor specialising in CTP claims. They can help ensure your treatment plan meets all legal requirements and that you don't miss critical deadlines.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.