How SIRA Defines Psychological Treatment Plans for 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 suffered a psychological injury in a motor accident in NSW, understanding what constitutes a valid psychological treatment plan is critical. SIRA (State Insurance Regulatory Authority) provides clear guidelines on what documentation is required to support claims for mental health treatment under the NSW Compulsory Third Party (CTP) scheme. This article explains SIRA's rules, what evidence matters, and how to navigate the process.
What SIRA Considers a Valid Psychological Treatment Plan
SIRA requires psychological treatment plans to be structured, evidence-based, and aligned with clinical guidelines. For a plan to be accepted, it must include:
- A clear diagnosis of a psychological condition (e.g., PTSD, depression) based on DSM-5 criteria
- Specific treatment goals tailored to the individual's needs
- A documented plan with measurable outcomes
- Regular progress notes from a registered psychologist
SIRA emphasizes that treatment must be 'reasonably necessary' and directly related to the accident. For example, a psychologist must demonstrate how the injury resulted from the accident and how the treatment addresses that specific condition.
Practical Steps and Evidence for CTP Claims
To support your claim, gather:
- Medical records from a registered psychologist or psychiatrist
- Accident details (date, location, circumstances)
- Insurer correspondence showing you've notified the at-fault driver's insurer
- Witness statements if available
- Income records if you're claiming lost wages
SIRA also requires a 'treatment plan' document from your mental health professional. This should outline the type of therapy (e.g., CBT), frequency, and expected duration. Electronic records are acceptable, but ensure they're legible and properly dated.
Time Limits and Dispute Resolution
Claims must be made within 52 weeks of the accident for benefits like weekly payments. After this period, SIRA may limit benefits unless the injury is classified as a 'threshold injury' (see MAIA s 4.4). If you dispute a decision, you can:
- Request a review from SIRA
- Lodge a complaint with the NSW Civil and Administrative Tribunal (NCAT)
- Seek legal advice if your claim is denied
When to Seek Legal Advice
SIRA's rules can be complex, especially when overlapping with workers' compensation or other schemes. A solicitor can help you:
- Navigate SIRA's application process
- Challenge decisions based on incorrect assumptions
- Ensure your treatment plan meets all regulatory requirements
If you're unsure whether your claim meets SIRA's standards, contact a legal professional. Every claim depends on its own facts.
Next Steps
CTP claims involving psychological injuries require careful documentation to meet SIRA's standards. If you're unsure about your eligibility or need help preparing your claim, complete the quick, no obligation enquiry form to request contact about your circumstances.