Part 5 classification
When is a psychological injury threshold in NSW CTP?
The current rule has two parts. Psychological or psychiatric symptoms that do not amount to a recognised psychiatric illness are threshold injuries. The Regulation also expressly includes acute stress disorder and adjustment disorder as threshold injuries. A recognised diagnosis such as PTSD may support non-threshold classification only when the diagnosis and accident causation are properly established.
Motor accident mechanism
What can happen in a motor accident?
Rear-end crash
Driving fear and sleep disturbance after a rear impact may be symptoms, an adjustment disorder, acute stress disorder or another recognised illness.
Side-impact crash
Intersection avoidance and hypervigilance after a side impact require diagnosis rather than classification from the symptom alone.
Motorcycle fall
Trauma symptoms after a motorcycle fall may change over time, making longitudinal diagnostic evidence important.
Pedestrian impact
A pedestrian may have distress, acute stress disorder, adjustment disorder or PTSD depending on the established criteria and course.
Injuries and diagnoses that may follow
- psychological symptoms below a recognised illness
- acute stress disorder, expressly threshold
- adjustment disorder, expressly threshold
- PTSD or another recognised illness requiring supported diagnosis
- organic brain-related behavioural change, which is a neurological rather than PIRS classification issue
Symptoms to record accurately
- fear, distress, worry or low mood
- sleep, concentration or irritability symptoms
- driving avoidance or hypervigilance
- intrusive memories or nightmares
- reduced social, work or daily function
Urgent health warning
Any immediate risk of self-harm, inability to remain safe or acute psychiatric crisis requires urgent clinical help.
Clinical evidence
What objective findings and records matter?
Classification should be based on the current diagnosis and supporting criteria, not a shorthand insurer label. The clinician should distinguish symptoms, acute stress disorder, adjustment disorder, PTSD, depression and any organic brain condition.
| Record or test | What it can establish | What it cannot establish alone |
|---|---|---|
| DSM-5-TR diagnostic assessment | Identifies whether symptoms meet a recognised illness and records the actual criteria. | A screening scale or referral description does not decide the legal classification. |
| Longitudinal treatment records | Show timing, duration, changing diagnosis and response to treatment. | A later diagnosis does not automatically apply retrospectively without explanation. |
| Causation assessment | Addresses the crash, physical injury, prior history and other stressors. | Temporal association alone may not answer competing causal explanations. |
| Insurer decision and medical material | Shows the exact diagnosis and reason relied on for classification. | An insurer’s label is reviewable and does not replace the statutory test. |
Part 5 classification
Is the injury threshold or non-threshold?
Act section 1.6 treats psychological or psychiatric injury that is not a recognised psychiatric illness as threshold. Regulation clause 4(2) then includes acute stress disorder and adjustment disorder as threshold despite being diagnostic labels. Guidelines clauses 5.10-5.12 require DSM-5-TR diagnostic assessment. Other recognised illnesses are not automatically accepted; their criteria and accident causation still need evidence.
Evidence consistent with a threshold classification
- symptoms without a recognised psychiatric illness
- acute stress disorder
- adjustment disorder
- an unsupported or provisional diagnosis
- a diagnosis not causally connected to the motor accident
Evidence that may support a non-threshold injury
- PTSD supported by DSM-5-TR criteria and accident causation
- major depressive disorder or another recognised illness properly established
- a reasoned specialist diagnosis supported by longitudinal records
- a separate physical neurological injury producing organic behavioural impairment
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?
Threshold status does not predict WPI. A non-threshold psychiatric diagnosis can still be assessed at 10% or less, while PIRS is applied only to permanent psychiatric impairment. Physical and psychiatric results cannot be combined to exceed 10%.
| Assessment question | Applicable method | Important limit |
|---|---|---|
| Classification | Act section 1.6, Regulation clause 4 and Guidelines clauses 5.10-5.12 control the threshold test. | PIRS classes are not used to decide whether a diagnosis is threshold. |
| Permanent psychiatric impairment | Clauses 6.201-6.228 use PIRS after diagnosis, causation and permanence are established. | A non-threshold classification does not guarantee any WPI percentage. |
| Greater-than-10% test | Physical and psychiatric impairment are considered separately under the current Act and Guidelines. | The two percentages cannot be added together. |
- First identify the current diagnosis and whether an express Regulation exception applies.
- Then decide accident causation and the evidence supporting the diagnosis.
- Only then, if permanent impairment is in issue, apply the separate PIRS method.
- Do not use work status, treatment duration or symptom count as a substitute for diagnosis.
- Do not combine physical and psychiatric percentages.
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 screening questionnaire
- a GP shorthand label without criteria
- a PIRS class used to decide threshold status
- combined physical and psychiatric WPI
Accident-specific examples
Adjustment disorder diagnosed after loss of work
It remains threshold under Regulation clause 4(2), even though it is a recognised diagnostic term.
PTSD alleged from nightmares and driving fear
Those symptoms are relevant but the complete recognised diagnosis and accident causation must be established before non-threshold classification follows.
Non-threshold PTSD with psychiatric WPI of 10% or less
Threshold classification and WPI are separate. Non-threshold status does not guarantee that the greater-than-10% test is met.
Claim file preparation
Evidence checklist
Assessment source
Threshold psychological injury 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.
Threshold injury: Symptoms below a recognised illness, acute stress disorder and adjustment disorder are threshold. Other recognised illnesses require supported diagnosis and accident causation.
What the assessor checks
- Act definition
- Regulation exceptions
- DSM-5-TR diagnostic method
- separation from PIRS and WPI
What does not establish the result by itself
- symptoms
- screening score
- unsupported label
- PIRS class
Official sources
Related NSW CTP guides
Free claim check
Review the diagnosis, insurer decision and evidence together
Send the accident date, insurer decision, relevant hospital or specialist reports, and any deadline shown. NSW CTP Claim is a specialised service of Stephen Young Lawyers. Legal services are provided by Stephen Young Lawyers.
Frequently asked questions
- What is a threshold psychological injury?
- It includes psychological symptoms that do not amount to a recognised psychiatric illness, plus acute stress disorder and adjustment disorder under the Regulation.
- Is every diagnosed condition non-threshold?
- No. Acute stress disorder and adjustment disorder are expressly threshold. Any other diagnosis must still be properly established and causally related.
- Is PTSD always non-threshold?
- No automatic result should be assumed. PTSD may be non-threshold when its criteria and accident causation are properly established.
- Does non-threshold mean WPI is greater than 10%?
- No. Threshold classification and WPI are separate legal and medical questions.
- Can physical WPI make up a psychiatric shortfall?
- No. Physical and psychiatric WPI cannot be combined for the greater-than-10% test.