Post-traumatic stress disorder
PTSD after a car accident
Post-traumatic stress disorder can follow a frightening crash, serious injury, rescue, hospital treatment or witnessing a motor accident. PTSD is not proved by distress or a screening score. A clinician must establish the recognised diagnosis, its connection to the accident and the functional consequences.
Motor accident mechanism
What can happen in a motor accident?
Rear-end crash
A sudden rear impact may produce intrusive recollection, fear of being struck again and avoidance of driving.
Side-impact crash
Side impact can create intense threat, helplessness and later avoidance of intersections or the struck side of traffic.
Motorcycle fall
A rider may experience PTSD after being thrown, trapped, seriously injured or returning to the road environment.
Pedestrian impact
A pedestrian may develop trauma symptoms after impact, witnessing the vehicle approach or experiencing prolonged rehabilitation.
Injuries and diagnoses that may follow
- PTSD meeting DSM-5-TR diagnostic criteria
- PTSD with depressive, panic or sleep symptoms
- PTSD associated with chronic physical injury or rehabilitation
- a different recognised anxiety or mood disorder
- acute stress or adjustment disorder that must not be mislabeled as PTSD
Symptoms to record accurately
- intrusive memories, nightmares or flashbacks
- avoidance of driving, roads, vehicles or discussion of the crash
- negative changes in mood, beliefs, interest or connection
- hypervigilance, startle, irritability and sleep disturbance
- concentration difficulty and reduced work, travel or social function
Urgent health warning
Urgent help is required for suicidal thoughts, inability to remain safe, severe dissociation or acute mental health crisis.
Clinical evidence
What objective findings and records matter?
The report should map the required symptom clusters, duration and impairment to DSM-5-TR criteria and distinguish PTSD from acute stress disorder, adjustment disorder, depression, pain-related distress and pre-existing trauma.
| Record or test | What it can establish | What it cannot establish alone |
|---|---|---|
| Psychiatric diagnostic interview | Examines trauma exposure, symptom clusters, duration, impairment, differential diagnoses and causation. | A PTSD checklist does not replace the interview or establish causation by itself. |
| GP and psychology chronology | Shows first disclosure, symptom course, treatment, medication and consistency. | Late presentation does not automatically disprove PTSD, but timing and alternative stressors must be addressed. |
| Functional evidence | Records driving, travel, relationships, concentration, self-care, work and adaptation. | One social outing or short drive does not establish sustainable function across all PIRS areas. |
| Prior history and collateral material | Allows the psychiatrist to compare pre-accident trauma, symptoms and function. | A pre-existing condition should not be assumed to explain all post-accident change. |
Part 5 classification
Is the injury threshold or non-threshold?
A properly established PTSD diagnosis is a recognised psychiatric illness and may support non-threshold classification. It is not automatic: the diagnostic criteria and accident causation must be established. If the symptoms do not amount to a recognised illness, or the correct diagnosis is acute stress disorder or adjustment disorder, the psychiatric injury is threshold.
Evidence consistent with a threshold classification
- trauma symptoms without a recognised diagnosis
- acute stress disorder
- adjustment disorder
- a PTSD label without supported DSM-5-TR criteria or accident causation
Evidence that may support a non-threshold injury
- psychiatrist-supported PTSD meeting DSM-5-TR criteria
- a consistent clinical chronology linking onset and persistence to the crash
- treatment and functional evidence consistent with PTSD
- reasoned consideration of pre-existing trauma and other stressors
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?
A PTSD diagnosis does not supply a WPI percentage. A psychiatrist applies PIRS to six areas of function after the condition is permanent or stable and causally related. The median class and aggregate score determine the Table 6.17 range.
| Assessment question | Applicable method | Important limit |
|---|---|---|
| Diagnosis and causation | Clause 6.213 requires the recognised diagnosis and criteria to be identified before PIRS. | A screening score or treatment letter alone is not the WPI method. |
| Functional assessment | Tables 6.11-6.16 measure self-care, social/recreational activity, travel, relationships, concentration and adaptation. | Symptoms should be translated into actual function without rating the same restriction indiscriminately in every table. |
| Calculation and treatment | Table 6.17 uses the median class and aggregate score; clauses 6.222-6.224 allow a limited treatment-effect adjustment only where all conditions are met. | Medication use does not automatically add a treatment percentage. |
- PIRS measures function, not the number of PTSD symptoms.
- The psychiatrist considers the claimant’s normal roles, culture, environment and sustainable function.
- Pre-existing psychiatric impairment is assessed using the same PIRS method where a deduction is supported.
- Physical injuries and psychiatric WPI remain separate for the greater-than-10% test.
- Pain and somatoform disorder are not rated through PIRS.
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?
- being frightened in the crash
- nightmares without a diagnostic assessment
- a screening questionnaire alone
- treatment or medication alone
- adding physical and psychiatric percentages
Accident-specific examples
Avoidance and nightmares soon after the crash
Early symptoms may fit acute stress disorder or another response. The diagnosis, duration and current Regulation treatment must be identified rather than assuming PTSD.
PTSD with improved symptoms but continuing travel restriction
PIRS considers current sustainable function across all six areas and any permitted treatment adjustment, not the diagnosis at its worst point.
PTSD and chronic physical injury
Both may be assessed, but psychiatric and physical WPI cannot be combined to pass the greater-than-10% threshold.
Claim file preparation
Evidence checklist
Assessment source
PTSD threshold and PIRS source
Assessment source: Motor Accident Guidelines v10.1 clauses 5.10-5.12 and 6.201-6.228; PIRS Tables 6.11-6.17; Motor Accident Injuries Act 2017 section 1.6 and Regulation 2017 clause 4(2)-(3).
Threshold injury: Supported PTSD may be non-threshold as a recognised psychiatric illness. Symptoms, acute stress disorder and adjustment disorder remain threshold under the current rules.
What the assessor checks
- DSM-5-TR diagnostic requirement
- PIRS six-function method
- median and aggregate calculation
- separate physical and psychiatric WPI
What does not establish the result by itself
- distress
- screening tool
- diagnosis label
- combined WPI
Official sources
Related NSW CTP guides
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Frequently asked questions
- Is PTSD a threshold injury?
- A properly established PTSD diagnosis may be non-threshold because it is a recognised psychiatric illness. Diagnosis and causation still need evidence.
- Is a PTSD questionnaire enough?
- No. Screening can assist clinical assessment but does not replace a diagnostic interview or establish accident causation.
- Does avoiding driving prove PTSD?
- No. Avoidance is relevant but can occur in several conditions. The complete DSM-5-TR criteria and differential diagnosis must be assessed.
- How is PTSD WPI calculated?
- A psychiatrist rates six PIRS functions, then applies the median class, aggregate score and Table 6.17. It is not calculated from symptom count.
- Can PTSD WPI be added to physical WPI?
- No. The two streams are assessed separately for the greater-than-10% test.