Psychiatric injury claim
Psychological injury after a car accident
Fear, distress and sleep disruption are common after a crash, but the CTP scheme distinguishes symptoms from a recognised psychiatric illness. It also treats acute stress disorder and adjustment disorder as threshold injuries under the current Regulation. Diagnosis, accident causation, treatment and functional impact must therefore be recorded precisely.
Motor accident mechanism
What can happen in a motor accident?
Rear-end crash
A frightening rear impact may lead to driving anxiety, intrusive recollection, sleep disturbance or a recognised psychiatric illness.
Side-impact crash
Unexpected lateral impact can produce fear, loss of control and later avoidance of intersections or travel.
Motorcycle fall
A rider may develop trauma symptoms after a fall, serious injury, hospital treatment or fear of returning to the road.
Pedestrian impact
A pedestrian may experience trauma symptoms from the impact, perceived threat, rehabilitation or witnessing injury to others.
Injuries and diagnoses that may follow
- post-traumatic stress disorder
- major depressive disorder or another recognised mood disorder
- an anxiety disorder linked to the accident
- acute stress disorder or adjustment disorder, which the Regulation treats as threshold injuries
- symptoms of distress that do not meet a recognised psychiatric diagnosis
Symptoms to record accurately
- intrusive memories, nightmares or physiological reactivity
- avoidance of driving, roads or crash reminders
- hypervigilance, startle, irritability or panic symptoms
- low mood, loss of interest, guilt or hopelessness
- poor sleep, concentration, social withdrawal or reduced work function
Urgent health warning
Immediate help is required for suicidal thoughts, inability to remain safe, severe deterioration or other mental health crisis. Contact emergency services or an appropriate crisis service.
Clinical evidence
What objective findings and records matter?
A useful psychiatric report identifies the DSM-5-TR diagnosis and criteria, explains how the crash caused or materially contributed to it, addresses prior mental health and records treatment and functional effects. A symptom checklist is not a substitute for diagnostic reasoning.
| Record or test | What it can establish | What it cannot establish alone |
|---|---|---|
| GP and psychologist records | Show first presentation, symptom progression, treatment, medication, certificates and day-to-day effect. | A psychologist can provide important treatment evidence but psychiatric WPI must be assessed by a psychiatrist. |
| Psychiatrist assessment | Identifies the recognised diagnosis, DSM criteria, causation, prognosis, stability and PIRS function. | A diagnosis label without criteria and functional analysis may not resolve classification or WPI. |
| Treatment and medication history | Shows duration, response, adherence, adverse effects and residual symptoms. | Receiving treatment does not itself prove a non-threshold injury or a particular percentage. |
| Functional and collateral evidence | Records self-care, relationships, travel, concentration, adaptation, work and social function. | One isolated activity does not establish sustained capacity or incapacity. |
Part 5 classification
Is the injury threshold or non-threshold?
Under Act section 1.6, psychological or psychiatric injury that is not a recognised psychiatric illness is threshold. Regulation clause 4(2) also expressly includes acute stress disorder and adjustment disorder as threshold injuries. A properly established recognised illness such as PTSD may be non-threshold, but diagnosis and causation must be proved; not every anxiety, depression or trauma complaint is automatically non-threshold.
Evidence consistent with a threshold classification
- distress or symptoms that do not meet a recognised psychiatric illness
- acute stress disorder
- adjustment disorder
- a diagnostic label without supported DSM-5-TR criteria or accident causation
Evidence that may support a non-threshold injury
- a psychiatrist-supported recognised psychiatric illness other than the Regulation exceptions
- documented DSM-5-TR criteria and accident causation
- a longitudinal treatment record supporting the diagnosis
- functional evidence consistent with the recognised illness
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?
Psychiatric WPI is a separate question from threshold classification. A psychiatrist applies the six Psychiatric Impairment Rating Scale tables in clauses 6.201-6.228 after diagnosis, causation and permanence are established. The result is not calculated from symptom severity or diagnosis alone.
| Assessment question | Applicable method | Important limit |
|---|---|---|
| Diagnosis | Clause 6.213 requires a recognised DSM or ICD psychiatric diagnosis and identification of the criteria used. | Symptoms or treatment attendance without diagnostic reasoning are insufficient. |
| Six areas of function | PIRS Tables 6.11-6.16 assess self-care, social/recreational activity, travel, relationships, concentration and adaptation. | Work status is relevant to adaptation but does not determine every table. |
| Final calculation | Clauses 6.225-6.228 use the median class, aggregate score and Table 6.17, followed by any permitted treatment adjustment. | Physical and psychiatric WPI cannot be combined to exceed 10%. |
- PIRS is applied by a trained psychiatrist using clinical judgment and the claimant’s cultural and social context.
- The same functional restriction should not be inflated across every PIRS table without evidence.
- Pre-existing psychiatric impairment, if present, is assessed by the same PIRS method and deducted where supported.
- Organic brain-related mental or behavioural impairment uses the neurological method rather than PIRS.
- Somatoform disorders and pain are not measured by PIRS under clause 6.215.
The six PIRS tables
Psychiatric WPI is assessed across six areas of function. A psychiatrist assigns a class from the evidence in each area; the classes are not percentages and are not simply added or averaged.
| Guidelines table | Function assessed | Examples of useful evidence |
|---|---|---|
| Table 6.11 | Self-care and personal hygiene | washing, dressing, meals, medication and ordinary personal routines |
| Table 6.12 | Social and recreational activities | participation, initiation, frequency, support and withdrawal from usual activities |
| Table 6.13 | Travel | independent travel, public transport, driving, unfamiliar routes and support needed |
| Table 6.14 | Social functioning and relationships | family, friends, communication, conflict, isolation and capacity to maintain relationships |
| Table 6.15 | Concentration, persistence and pace | task completion, errors, supervision, breaks, reliability and sustained mental effort |
| Table 6.16 | Adaptation | response to work-like demands, stress, change, attendance and pre-injury roles where relevant |
Verified calculation example from the Guidelines
If the six supported class ratings are 2, 2, 3, 3, 4 and 4, the median class is 3 and the aggregate score is 18. Table 6.17 gives 22% WPI before any valid treatment adjustment. This demonstrates the calculation only. It is not a way to estimate WPI from symptoms without a psychiatrist’s assessment.
What does not establish the result by itself?
- distress or fear alone
- a symptom questionnaire alone
- a diagnosis label without criteria
- treatment attendance alone
- combining physical and psychiatric percentages
Accident-specific examples
Driving anxiety without a recognised diagnosis
The symptoms may require treatment, but they remain threshold unless the evidence establishes a recognised psychiatric illness outside the Regulation exceptions.
PTSD diagnosis supported by criteria and treatment history
This may support a non-threshold psychiatric injury. Any WPI is still separately assessed using PIRS after permanence and causation are established.
Pre-existing depression worsened after the crash
The psychiatrist should compare pre- and post-accident function, address causation and apply the same PIRS method to any supported pre-existing impairment deduction.
Claim file preparation
Evidence checklist
Assessment source
Psychological injury classification and WPI source
Assessment source: Motor Accident Injuries Act 2017 section 1.6; Motor Accident Injuries Regulation 2017 clause 4(2)-(3); Motor Accident Guidelines v10.1 clauses 5.10-5.12 and 6.201-6.228, including PIRS Tables 6.11-6.17.
Threshold injury: Symptoms below a recognised psychiatric illness are threshold. Acute stress disorder and adjustment disorder are also expressly threshold. Other recognised illnesses require diagnosis and causation evidence.
What the assessor checks
- current threshold definition
- Regulation exceptions
- DSM-5-TR diagnostic approach
- six-table PIRS method and separate physical/psychiatric rule
What does not establish the result by itself
- distress
- screening score
- diagnosis label
- combined physical and psychiatric WPI
Official sources
Related NSW CTP guides
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Frequently asked questions
- Is anxiety after a crash automatically non-threshold?
- No. The evidence must establish a recognised psychiatric illness and accident causation. Symptoms alone remain threshold.
- Are adjustment disorder and acute stress disorder threshold injuries?
- Yes. Current Regulation clause 4(2) expressly includes both as threshold injuries.
- Who assesses psychiatric WPI?
- A psychiatrist trained in the PIRS method assesses permanent psychiatric impairment.
- Can a psychologist diagnose and treat my condition?
- Psychologist evidence can be important for diagnosis and treatment. The Guidelines require psychiatric WPI to be assessed by a psychiatrist.
- Can psychiatric and physical WPI be added together?
- No. They are assessed separately and cannot be combined to determine whether impairment is greater than 10%.