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A knock to the head is a clinical event, not an inconvenience
Head injuries after a collision get talked out of existence at the roadside. The car was drivable, nobody went to hospital, and everyone agreed you were lucky. Days later you are squinting at your own kitchen light, sleeping badly and re-reading the same email four times. Nothing about that is imaginary, and none of it improves faster for being ignored.
This page is written by the clinicians who assess head injuries after motor accidents. It covers what concussion is, the symptoms that mean stop reading and get to an emergency department, what happens at your first appointment with our doctors, and how the treatment and the paperwork get funded under the NSW compulsory third party scheme. If you have not seen anyone about this yet, our car accident injury service is where to start.
1. What concussion actually is
Concussion is a mild traumatic brain injury. Force is transmitted to the head, the brain is briefly disturbed in how it functions, and the effects show up in the way you feel, think, sleep and cope for a while afterwards. The important and widely misunderstood part is that the head does not have to strike anything. A body restrained by a seatbelt while the head keeps travelling produces exactly the acceleration and deceleration that causes it. That is also why concussion and neck injury so often arrive together in the same crash, and why our examination always covers both.
Symptoms fall into four families. Most people notice two or three of them rather than all four, and almost nobody notices them at the scene, because adrenaline is very good at hiding the lot for several hours.
Physical
Headache, nausea, dizziness, blurred vision, sensitivity to light and noise, unsteadiness on your feet, neck pain that travels up into the skull.
Thinking
A foggy, underwater quality to concentration, slowed processing, losing the thread mid-sentence, and gaps in memory around the moments before and after impact.
Mood
Irritability that surprises you, tearfulness, a short fuse with people you are normally patient with, and anxiety that feels out of proportion to the day.
Sleep
Sleeping far more or far less than usual, waking unrefreshed, and an afternoon fatigue that arrives like a wall rather than a slope.
Most people improve substantially over the first weeks. A minority do not, and that minority is the entire reason assessment is worth doing while the injury is fresh rather than once it has become a habit.
2. The signs that mean an emergency department, now
A small number of head injuries are not a matter for an appointment next week. If any of the following appears, in you or in someone you are with, stop and call 000 or go straight to the nearest emergency department.
- ⚠A headache that keeps building instead of settling
- ⚠Vomiting more than once
- ⚠A seizure or convulsion of any kind
- ⚠Weakness, numbness or clumsiness in an arm or a leg
- ⚠Slurred speech, or trouble understanding what is said to you
- ⚠Growing drowsiness, or being hard to rouse
- ⚠Confusion that deepens rather than clears
- ⚠Pupils of different sizes, or double vision that will not resolve
- ⚠Clear fluid or blood coming from the nose or an ear
- ⚠Losing consciousness after a period of seeming fine
Three groups should default to emergency assessment on the day rather than weighing it up: anyone who was knocked out at the scene, anyone taking a blood thinner, and anyone whose symptoms are getting worse instead of better. Emergency treatment after a motor accident, ambulance included, sits inside what the CTP scheme covers, so cost is not a reason to hesitate.
3. You did not have to black out for this to count
Loss of consciousness is not a requirement. It never was. Plenty of concussions involve no blackout at all, and the question that decides whether yours is documented properly is simply whether someone trained to look at it actually looked, early, and wrote down what they found.
There are two reasons that matters. The clinical one is that recovery is judged on change. Balance, eye movement, symptom load and cognitive tolerance mean very little as a single reading and a great deal as a trend, so the first examination is what makes every later one interpretable. The administrative one is blunter. A CTP insurer works from the clinical record it is given, and it has to tell you whether it accepts liability for statutory benefits in the first 52 weeks within four weeks of the claim. A head injury that appears in the file for the first time months later is a harder thing to describe honestly and a harder thing to fund.
Source: Motor Accident Injuries Act 2017 s 6.19(1). Checked September 2026.
4. What our doctors do, and the certificate that follows
The first appointment starts with mechanism. Where you were sitting, what the vehicle did, whether the head struck anything, whether there is a gap in your memory and how wide it is. From there our doctors screen for the emergency signs above, examine balance, eye movement, neck and cognition, take a symptom baseline you can be measured against later, and decide whether imaging is warranted. Most concussions do not need a scan. Imaging is requested when the examination points to something a scan would change, not as a formality.
Then there is the document that keeps your weekly payments alive. Your Certificate of Fitness records what you can and cannot do, and the scheme is specific about who writes it. The first certificate must come from a treating medical practitioner. A certificate covers a period of no more than 28 days. Second and subsequent certificates may be issued by a medical practitioner or by your treating physiotherapist or psychologist, which is exactly the flexibility a concussion needs, because capacity after a head injury moves week to week. Our Certificate of Fitness guide walks through the form itself.
Source: SIRA, Motor Accident Guidelines 4.68 and 4.69; Motor Accident Injuries Act 2017 s 3.15. Checked September 2026.
5. What gets funded while you recover
Before a claim exists there is a short runway. In the first 28 days after the crash an insurer may fund one GP consultation and two allied health treatment sessions ahead of a claim being made. It is discretionary, it needs the insurer notified and a claim or reference number issued, and it closes at day 28. Once a claim is in, treatment is funded where it is reasonable and necessary and related to the crash injury, and the insurer is to answer a treatment request as soon as possible and no later than 10 days from receiving it.
Treatment for concussion is rarely dramatic and almost never a darkened room for a fortnight. It is education about what is happening to you, a graded return to activity pitched just below the level that sets symptoms off, targeted work on the neck and the vestibular system where the examination points there, practical management of headache and sleep, and psychological input when mood or anxiety is what is holding recovery up. Reviews are the mechanism: each one measures against the baseline and sets the next block of treatment. How the insurer decides all of this is set out on our treatment approvals page.
Source: SIRA, Motor Accident Guidelines 4.78, 4.79 and 4.106. Checked September 2026.
6. Going back to work, and back behind the wheel
Return to work after a concussion is a question about cognitive load rather than physical capacity, which is why a desk job is often harder to resume than a quiet outdoor one. Screens, open-plan noise, back-to-back meetings and decisions under time pressure are the things that reliably provoke symptoms. A useful certificate says so in real terms, naming hours, tasks and breaks, instead of declaring you fit or unfit in the abstract. That specificity is what lets an employer build something workable and what stops a premature full return from undoing a fortnight of progress.
Driving is its own assessment. It asks for reaction time, visual tracking, divided attention and tolerance of fatigue and glare, and concussion can dull all four while the rest of your day looks close to normal. Our doctors examine those capacities specifically. And if what stops you getting into the car is not function but fear, that is a genuinely different problem with a genuinely different treatment, and our psychological injury page covers it.
7. Head injury and the threshold question
The NSW scheme sorts injuries into two groups, and the sorting decides how long your benefits run. The part of section 1.6 of the Motor Accident Injuries Act 2017 that matters to a head injury is short: a threshold injury is a soft tissue injury, and soft tissue means the connecting and supporting tissue of the body. The full list of tissues, and the exclusions that decide most other files, is set out in section 6 of our NSW car accident injury guide.
Brain tissue is not connecting or supporting tissue, so a head injury that leaves lasting effects is capable of sitting outside the threshold category. Nobody should read that as a promise. It is decided on clinical evidence, and evidence has to be created before it can be weighed. What the classification changes is substantial. For a threshold injury, or for a person wholly or mostly at fault, weekly payments run for 52 weeks and treatment and care run for 52 weeks. For an injury that is not a threshold injury, where you were not mostly at fault, weekly payments run for up to 104 weeks and treatment and care continue for as long as they remain reasonable and necessary.
The weekly amounts step down over time. For the first 13 weeks the rate is 95 per cent of the difference between your pre-accident weekly earnings and what you can earn now. From week 14 to week 78 it is 80 per cent where you have lost your earnings entirely and 85 per cent where the loss is partial.
Source: Motor Accident Injuries Act 2017 ss 1.6, 3.6, 3.7, 3.11 and 3.28. Checked September 2026.
8. How to get seen
Three dates are worth writing down. The accident should be reported to police within 28 days, and sooner is better. A statutory benefits claim lodged within 28 days has weekly payments back-dated, and a claim lodged later than that does not, which is the most common and most avoidable loss in the whole scheme. A claim must be made within 3 months of the accident.
Booking with us is one phone call. Our doctors assess the head injury and write the first certificate. Our physiotherapists and psychologists take it from there, working from the same file rather than starting your story over. We are a treating clinic, not a law firm; where a matter genuinely needs legal advice we can refer you to a partner law firm, and that is the extent of it. If your crash happened while you were working, read our work-related car accident page first, because you may have two claims rather than one.
Source: SIRA, Guide for people injured in a motor vehicle accident; Motor Accident Injuries Act 2017 s 6.13. Checked September 2026.