NSW CTP claims: brain injury and psychological assessments

After a car accident in NSW, some injuries are easy to see. Others, such as a mild brain injury, post-traumatic stress or depression, can be harder to recognise. If you are making an NSW CTP brain injury or psychological injury claim, knowing the rules early can make a real difference.

This guide explains how the Compulsory Third Party (CTP) Green Slip scheme works under the Motor Accident Injuries Act 2017, and where neuropsychological and psychological assessments fit.

How the NSW CTP scheme works

Every registered vehicle in NSW has a CTP Green Slip. The scheme is regulated by the State Insurance Regulatory Authority (SIRA). SIRA’s guide for people injured in a motor crash explains that anyone injured in a crash on a NSW road on or after 1 December 2017 can apply. That includes drivers, passengers, motorcycle riders, cyclists and pedestrians, and covers both physical and psychological injuries.

Time limits to know

• Report the crash to police within 28 days.
• Lodge your claim within 3 months of the crash.
• Lodge within 28 days if you want lost earnings paid from the date of the crash.
• Common law damages claims generally need to be made within 3 years of the crash.

Statutory benefits and threshold injuries

For the first 52 weeks, you can usually claim statutory benefits. These cover medical and treatment costs, part of your weekly earnings if you cannot work, and some care costs. People who were wholly or mostly at fault are generally limited to benefits for up to 52 weeks.

After 52 weeks, whether benefits continue depends partly on whether you have a “threshold injury”. SIRA’s threshold injury guide explains that there are two types:

• Soft tissue injuries, such as whiplash and muscle strains.
• Threshold psychological or psychiatric injuries. Of the recognised psychiatric illnesses, only adjustment disorder and acute stress disorder are threshold injuries.

Conditions such as post-traumatic stress disorder (PTSD) and depression are not threshold injuries. Fractures, nerve injuries and some ligament and tendon injuries are also outside the threshold category. The insurer decides whether an injury is a threshold injury. If you disagree, you can ask for an internal review, and after that the Personal Injury Commission can resolve the dispute.

Why accurate diagnosis matters

Because the threshold rules depend on diagnosis, a careful psychological assessment matters. For example, symptoms that look like a short-term stress reaction in the first weeks may later meet criteria for PTSD or a depressive disorder. A clinician who takes a full history and uses validated measures can describe what is happening and how it has changed over time.

Brain injury after a car accident

A traumatic brain injury (TBI) happens when a blow or sudden movement disrupts how the brain works. It ranges from mild (often called concussion) to severe.

Signs of a brain injury can include:

• memory gaps around the crash, or trouble learning new information
• poor concentration and slower thinking
• headaches, dizziness, and sensitivity to light or noise
• fatigue, irritability or changes in personality
• difficulty planning, organising or managing work

Many of these symptoms overlap with pain, poor sleep, anxiety and depression, which are also common after a crash. That overlap is one reason a neuropsychological assessment can help. It can separate out the likely causes of thinking problems, which then guides the right treatment. For example, poor sleep and pain may respond to different help than a memory problem caused by the injury itself.

Severe brain injury and Lifetime Care

People with a severe injury may be eligible for icare’s Lifetime Care and Support Scheme. It is a no-fault scheme, so support does not depend on who caused the crash. For brain injury, the criteria include evidence such as post-traumatic amnesia (a period of confusion and memory loss after the injury) lasting longer than one week, or other evidence of a severe injury, along with measured functional impairment.

Damages claims and permanent impairment

SIRA’s page on applying for common law damages explains that you may be able to claim damages if someone else was at fault and your injuries are more than threshold injuries. Damages can include past and future loss of earnings.

Damages for non-economic loss (pain and suffering) need a permanent impairment of greater than 10%. Under Part 6 of the Motor Accident Guidelines, physical and psychological impairment must be assessed separately, and the two ratings cannot be combined to reach the 10% threshold. After a crash, a person may have both a brain injury and a psychological injury, so clear evidence about which problems come from which injury is important.

Where assessments fit

Treating assessments

A treating psychologist or neuropsychologist assesses you to plan recovery. A neuropsychological assessment measures memory, attention, processing speed, language and problem-solving, and considers how pain, mood and sleep are affecting results. The report can guide rehabilitation, return to work or study, and support at home. It also describes your strengths, which helps when planning what you can safely do now. A repeat assessment later can show whether things are improving, which is useful for both recovery planning and your claim. If you want the insurer to pay, check what approval it needs before booking.

Insurer and medico-legal assessments

The insurer may arrange an independent assessment, and your lawyer may ask for an independent neuropsychological or psychological report. Permanent impairment disputes can be referred to medical assessors at the Personal Injury Commission. Our guide on independent medical examinations explains what to expect.

Practical steps after a crash

• See a doctor soon after the crash, even if you feel fine. Some brain injury symptoms appear or become clearer over the following days.
• Tell your doctor about any memory gaps, confusion or loss of consciousness at the scene.
• Keep a simple diary of symptoms, such as headaches, fatigue, forgetfulness and mood changes, and how they affect work and home life.
• Ask a family member or friend to note changes they see in you. Others often notice changes before we do.
• Keep copies of hospital discharge papers, scans, receipts and letters from the insurer.
• Get legal advice early if you think you may have a damages claim, because time limits apply.

How Invictus Health can help

We have assessment clinics in NSW and several other states. Our neuropsychologists provide neuropsychological assessments after brain injury, and we prepare independent medico-legal assessments for lawyers and insurers. Neuropsychology reports are reviewed by Dr Judy Tang OAM.

You can self-refer for most assessments. If you want your CTP insurer to pay, ask them about approval first. Our fees page has more information. Our psychologists also provide counselling in person in Preston or by telehealth.

This article is general information, not legal advice. Speak with SIRA, your insurer or a lawyer about your claim, and a doctor about your symptoms. If you are in danger, call 000. For 24-hour crisis support call Lifeline on 13 11 14.