Understanding PTSD Claims Under the NSW CTP Scheme
Post-traumatic stress disorder (PTSD) resulting from a motor vehicle accident in New South Wales may be compensable under the Compulsory Third Party (CTP) insurance scheme. The Motor Accident Injuries Act 2017 (MAIA) governs all CTP claims in NSW, including psychological injuries. To qualify for compensation, a person must have suffered an injury due to a motor accident, and the injury must meet the legal definition of a threshold injury under the Act.
A threshold injury includes a soft tissue injury and a psychological or psychiatric injury that is not a recognised psychiatric illness, such as adjustment disorder or acute stress disorder (MAIA s 1.6). PTSD may fall within this definition if it arises from a motor accident and meets the clinical criteria set out in the Motor Accident Guidelines. However, not all psychological injuries are automatically considered threshold injuries. The presence of a recognised psychiatric illness may affect eligibility for statutory benefits.
Critical Early Actions for a PTSD Claim
To support a CTP claim for PTSD, injured road users must act promptly and document key elements. The following steps are essential in the early stages:
- Seek medical assessment from a registered medical practitioner or mental health professional as soon as symptoms appear. A diagnosis of PTSD must be made using accepted clinical standards, such as the DSM-5, and must clearly link the condition to the motor accident.
- Preserve all evidence related to the accident, including police reports, witness contact details, photographs of the scene or vehicle damage, and any correspondence with insurers.
- Notify the insurer of the at-fault driver or your own insurer within 52 weeks of the accident. While there is no strict deadline for making a claim, delays may affect access to statutory benefits.
- Obtain a specialist report from a psychologist or psychiatrist that details the onset of symptoms, their severity, and how they impact daily life, including work, relationships, and self-care.
Statutory Benefits and Time Limits
Under the MAIA, statutory benefits such as treatment and care, and weekly income payments, are generally limited to 52 weeks for injuries that do not meet the threshold injury criteria. However, where a person’s only injuries resulting from the accident are threshold injuries, weekly benefits and treatment and care benefits generally cease after 52 weeks (MAIA ss 3.11 and 3.28).
PTSD may qualify as a threshold injury if it meets the statutory definition and is supported by clinical evidence. If so, the injured person may be entitled to statutory benefits for up to 52 weeks. Beyond that period, further support may only be available through a common law damages claim, which requires proof of fault and a higher burden of proof.
Claiming Damages for Psychological Injury
A claim for damages under common law for PTSD requires proof that the injury was caused by the accident and that the at-fault party was negligent. Unlike statutory benefits, damages are not automatically payable and must be established through evidence, including medical reports, employment records, and evidence of functional impact.
SIRA (State Insurance Regulatory Authority) provides a framework for claims, including dispute resolution processes. If a claim is disputed, the injured person may request a review through SIRA’s internal process or seek independent medical advice to challenge the insurer’s assessment.
When to Seek Assistance
While it is not mandatory to seek legal advice to make a CTP claim, a solicitor can help navigate complex psychological injury claims, particularly where there is a dispute over eligibility, the extent of injury, or the value of a settlement. Legal advice may be particularly useful if symptoms persist beyond 52 weeks, if the claim is rejected, or if a damages claim is being considered.
Example: A Cyclist’s PTSD Claim
A cyclist in Greater Sydney was struck by a car while riding on a shared path. Following the incident, the cyclist experienced recurring flashbacks, sleep disturbances, and an inability to return to work. A psychologist diagnosed PTSD and provided a report linking the symptoms to the accident. The cyclist submitted the report, along with a police report and witness statements, to SIRA. SIRA accepted the claim as a threshold injury and approved treatment and care benefits, as well as a damages claim for psychological harm.
Next Steps
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.