What the PIC Expects in Psychological Treatment Plan Disputes
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).
The Personal Injury Commission (PIC) in New South Wales expects psychological treatment plans for motor accident claims to meet specific criteria. If your claim is disputed, the PIC will assess whether your treatment plan aligns with its guidelines. Key factors include evidence of a diagnosed mental health condition, a structured treatment plan with measurable goals, and documentation showing the connection between your injury and treatment.
NSW CTP Rules Behind the Question
Under the Motor Accident Injuries Act 2017, psychological treatment is covered as part of 'treatment and care benefits' if it's directly related to a threshold injury. The PIC evaluates whether the treatment plan is 'reasonably necessary' and 'directly related' to the injury. For disputes, the PIC may request additional evidence, such as clinical notes, psychologist reports, or a treatment plan outlining specific interventions.
Practical Steps and Evidence That Usually Matter
To support your psychological treatment plan, gather:
- A diagnosis from a registered psychologist or psychiatrist
- A written treatment plan with specific goals (e.g., reducing anxiety, improving sleep)
- Evidence of how the treatment addresses symptoms caused by your injury
- Records of attendance and progress notes
The PIC may dispute a plan if it lacks clear links to your injury or if the treatment appears generic rather than tailored. For example, a plan that only states 'cognitive behavioural therapy' without explaining how it addresses your specific symptoms may be challenged.
Time Limits, Disputes and When to Seek Advice
You have 52 weeks from the accident date to claim treatment and care benefits for threshold injuries. If your claim is disputed, the PIC may request a review or refer the matter to a medical expert. It's important to seek legal advice if:
- The PIC rejects your treatment plan without explanation
- You receive a notice of disagreement
- You need to challenge the PIC's decision
The PIC's internal review process typically takes 28 days, but delays can occur. A solicitor can help you prepare a formal objection or request a medical assessment to support your case.
Example of a Disputed Treatment Plan
A claimant involved in a Western Sydney motor accident submitted a treatment plan for depression. The PIC disputed it, arguing the plan lacked evidence of a direct link to the accident. The claimant's psychologist later provided additional records showing post-accident symptoms and a treatment plan tailored to address trauma-related anxiety. This additional evidence helped resolve the dispute.
Next Steps
If your psychological treatment plan is being challenged, act quickly. The PIC's decisions are final unless you request a review or challenge them through the NSW Civil and Administrative Tribunal (NCAT). For personalized guidance, complete the quick, no obligation enquiry form to discuss your circumstances.