Persistent concussion symptoms
Post-concussion symptoms after a motor accident
Symptoms can continue after the expected early recovery from concussion, but “post-concussion syndrome” is not a WPI category. The clinical task is to identify the cause of each ongoing problem, including neurological, vestibular, cervical, visual, sleep, migraine or psychiatric factors, and then apply the assessment method for any permanent accident-related impairment.
Motor accident mechanism
What can happen in a motor accident?
Rear-end crash
A rear impact may produce concussion and neck injury together, leaving overlapping headache, dizziness and concentration symptoms.
Side-impact crash
Rotational force can produce a mixed brain, vestibular and cervical presentation that requires differential assessment.
Motorcycle fall
A rider may have concussion, migraine, balance and psychological symptoms after a helmeted impact.
Pedestrian impact
Head and body trauma may create several causes for persistent fatigue, headache and reduced activity tolerance.
Injuries and diagnoses that may follow
- persistent symptoms following a clinically diagnosed concussion
- post-traumatic migraine or headache requiring neurological analysis
- vestibular or oculomotor dysfunction
- cervicogenic headache or neck soft tissue injury
- separate sleep, psychiatric or pain conditions affecting recovery
Symptoms to record accurately
- headache, pressure, nausea or sensory sensitivity
- dizziness, vertigo, visual motion sensitivity or imbalance
- fatigue, poor sleep and limited cognitive endurance
- memory, attention or processing complaints
- anxiety, driving avoidance, irritability or low mood
Urgent health warning
A new or worsening neurological deficit, seizure, repeated vomiting, altered consciousness or severe escalating headache is not simply a persistent symptom and requires urgent medical assessment.
Clinical evidence
What objective findings and records matter?
The evidence should not assume all ongoing symptoms come from one diagnosis. A useful assessment tests competing explanations and records how symptoms behave under treatment and ordinary activity.
| Record or test | What it can establish | What it cannot establish alone |
|---|---|---|
| Longitudinal GP and specialist record | Shows onset, change, treatment response, medication and whether symptoms remained continuous after the crash. | Repeated symptom lists without examination or differential diagnosis may add little. |
| Neurological and headache assessment | Can distinguish migraine, focal neurological injury and other causes of headache or cognitive change. | Headache frequency does not itself set neurological WPI. |
| Vestibular and visual assessment | May identify positional vertigo, vestibulo-ocular dysfunction, eye-movement or balance findings. | Dizziness without objective vestibular dysfunction does not establish vestibular WPI. |
| Neuropsychology, OT and rehabilitation | May examine cognition, pacing, task tolerance and functional consistency. | Testing and activity logs must be interpreted with pain, sleep, medication and psychological factors. |
Part 5 classification
Is the injury threshold or non-threshold?
Persistent symptoms do not create a separate non-threshold injury. Classification follows the medically established underlying injury. A supported brain, nerve or vestibular injury may be non-threshold; a neck soft tissue injury or psychological symptoms below the recognised-illness test may remain threshold.
Evidence consistent with a threshold classification
- persistent symptoms without a supported neurological diagnosis
- cervical soft tissue headache without radiculopathy or structural injury
- dizziness without an established vestibular injury
- distress or anxiety not amounting to a recognised psychiatric illness
Evidence that may support a non-threshold injury
- a supported accident-related brain injury
- objectively established vestibular or cranial nerve injury
- structural neurological pathology linked to the crash
- a recognised psychiatric illness other than acute stress disorder or adjustment disorder
Separate questions: threshold injury classification does not set WPI, and receiving statutory benefits does not automatically create a common law damages entitlement.
Part 6 permanent impairment
How is WPI assessed for this injury?
There is no standalone “post-concussion syndrome” percentage. The assessor identifies the permanent function affected and uses the applicable Part 6 method. Cognitive or organic behavioural impairment may use the modified Chapter 4 method; vestibular, visual, cervical and psychiatric impairment follow their own rules.
| Assessment question | Applicable method | Important limit |
|---|---|---|
| Persistent cognitive difficulty | If the clause 6.164 prerequisites are met, the assessor may use Tables 6.9 and 6.10 and consider available psychometric evidence. | Subjective brain fog without the required injury evidence does not become a CDR rating. |
| Dizziness or balance | Clauses 6.187-6.188 require objective vestibular dysfunction and modify the AMA4 vestibular class ranges. | Dizziness from migraine, medication, neck injury or anxiety must not be misclassified as vestibular impairment. |
| Psychiatric consequences | A psychiatrist assesses permanent recognised psychiatric impairment using PIRS. | Physical and psychiatric impairment remain separate for the greater-than-10% test. |
- The diagnosis and cause of each persistent symptom should be established before choosing an impairment method.
- A single symptom must not be rated twice under neurological, vestibular, cervical and psychiatric methods.
- Headache and pain are generally included in the relevant structural rating rather than separately assessed under AMA4 Chapter 15.
- The condition must be sufficiently permanent or stable before WPI can be reliably assessed.
Modified Clinical Dementia Rating for brain injury
Table 6.9 considers memory, orientation, judgment and problem-solving, community affairs, home and hobbies, and personal care. Table 6.10 then maps the supported overall CDR score to a WPI class. Clause 6.164 must be satisfied before this mental-status method is used.
| CDR score | Table 6.10 class | Class range |
|---|---|---|
| 0.5 | Class 1 | 1-14% WPI |
| 1.0 | Class 2 | 15-29% WPI |
| 2.0 | Class 3 | 30-49% WPI |
| 3.0 | Class 4 | 50-70% WPI |
The class is a range, not an automatic percentage. The medical assessor must select and explain the specific percentage from the complete clinical, psychometric and functional evidence.
What does not establish the result by itself?
- the duration of symptoms alone
- a checklist score without differential diagnosis
- normal imaging used to dismiss all symptoms
- an abnormal scan unrelated to the symptom pattern
- adding separate ratings for the same functional loss
Accident-specific examples
Dizziness improves after positional treatment
That response may support a specific vestibular diagnosis. Any lasting vestibular WPI still requires objective dysfunction under clauses 6.187-6.188.
Headache with neck tenderness and no brain findings
The ongoing complaint may be cervicogenic and threshold if it remains a soft tissue injury. Calling it post-concussion does not change the legal test.
Cognitive symptoms plus PTSD
Organic neurological and psychiatric impairments require separate diagnosis and methods. They cannot be combined to cross the greater-than-10% threshold.
Claim file preparation
Evidence checklist
Assessment source
Post-concussion symptom assessment source
Assessment source: Motor Accident Guidelines v10.1 clauses 5.1-5.12, 6.156-6.176 and 6.187-6.188; AMA4 Chapter 4 or Chapter 9 only through the applicable Part 6 method.
Threshold injury: The symptom label does not decide threshold status. Classification and WPI follow the established underlying neurological, vestibular, cervical or psychiatric injury.
What the assessor checks
- diagnosis-specific method
- modified central nervous system assessment
- objective vestibular requirement
- separate psychiatric WPI
What does not establish the result by itself
- symptom persistence
- checklist score
- imaging alone
- double counting
Official sources
Related NSW CTP guides
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Frequently asked questions
- Is post-concussion syndrome a fixed WPI category?
- No. The assessor identifies the specific permanent function affected and applies the relevant Part 6 method.
- Why can persistent symptoms have several causes?
- Headache, dizziness, fatigue and concentration difficulty can arise from brain, neck, vestibular, visual, sleep, migraine or psychological conditions. Differential assessment prevents the wrong method being used.
- Can symptoms be non-threshold without an abnormal scan?
- Potentially, if a non-threshold injury is medically established. The classification does not depend on imaging alone.
- When is WPI assessed?
- When any relevant impairment is sufficiently permanent or stable. There is no reliable percentage to infer during fluctuating early recovery.
- Can headache receive separate pain WPI?
- Generally no. Clause 6.162 includes headache and pain in the relevant structural impairment, and the AMA4 Pain chapter is not separately used.