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The part of a crash nobody writes on the form
Ask most people what they were injured in a collision and they will describe the neck, the shoulder, the wrist. Ask them what has actually changed about their week and the answer is often something else entirely: they take three buses instead of driving, they will not let their partner take the motorway, and they lie awake replaying a sound. That is an injury. It is treatable, and in New South Wales it is funded through the compulsory third party scheme in the same way a physical injury is.
This page explains how psychological injury after a motor accident is treated and how the scheme classifies it, because the classification decides how long your treatment is paid for. If you are having thoughts of harming yourself, please stop reading and call 000 or go to your nearest emergency department. Everything below is written for the longer, slower version of this problem.
1. When the car becomes the problem
A collision is a short, violent event in which your own control over what happens to you disappears completely. The nervous system takes a lesson from that, and the lesson is unhelpfully general: cars are dangerous, so avoid cars. In the weeks afterwards that shows up as reluctance rather than terror. You find reasons not to drive. You choose the long way round. You volunteer to be the one who stays home.
Two things make this worse than it needs to be. The first is that avoidance works, briefly, which is exactly what makes it stick. Every drive you do not take confirms the lesson. The second is that nobody names it. There is no bandage, no scan and no obvious moment at which somebody asks how you are actually coping, so people arrive at our psychologists months in, apologetic, having decided the problem is their character. It is not. It is a predictable response to a threatening event, and it responds to treatment far better when it is treated early.
2. What it looks like week to week
Psychological injury after a crash rarely announces itself. These are the presentations we see most often, and most people recognise several rather than all of them.
- ✓Avoiding driving altogether, or avoiding the road, intersection or manoeuvre where it happened
- ✓White-knuckle driving: hypervigilance, checking mirrors constantly, flinching at braking
- ✓Being unable to travel as a passenger, which is often the first thing families notice
- ✓Intrusive replays of the impact, or nightmares that wake you
- ✓Sleep that has broken down, and irritability that is out of character
- ✓Low mood, withdrawal, and losing interest in things that used to matter
- ✓Concentration that has gone, especially at work
- ✓Physical symptoms with no physical cause: racing heart, nausea, tight chest near traffic
Pain and mood also travel together. Where a physical injury from the same crash is still hurting, low mood and poor sleep make it hurt more, and the pain in turn feeds the mood. Treating one side of that loop while ignoring the other is the most common way a recovery stalls.
3. The line the scheme draws
Section 1.6 of the Motor Accident Injuries Act 2017 defines a threshold injury. For psychological injury the definition is short and consequential: a psychological or psychiatric injury is a threshold injury where it is not a recognised psychiatric illness. The Regulation then puts two named conditions explicitly on the threshold side, acute stress disorder and adjustment disorder as defined in DSM-5.
On the other side sit the recognised psychiatric illnesses, post-traumatic stress disorder and major depressive disorder among them. These are not threshold injuries. The distinction is not about how much distress a person is in, and it is not something anyone can settle in a phone call. It is a diagnosis made against published criteria, over more than one appointment, by a clinician who is treating you and watching how the picture develops.
We want to be plain about our part in that. The point is not to attract a label. The point is that the assessment is done carefully and written down accurately, so that a condition which genuinely meets the criteria for a recognised psychiatric illness is not recorded as a passing adjustment reaction simply because nobody looked twice.
Source: Motor Accident Injuries Act 2017 s 1.6; SIRA, Providing allied health services in the NSW CTP schemes — FAQs (updated 2 December 2025). Checked September 2026.
4. Why that line changes your benefits
A threshold classification puts a hard edge on the calendar: 52 weeks of weekly payments, 52 weeks of treatment and care. Being wholly or mostly at fault does the same thing. An injury that falls outside the threshold definition, where you were not mostly at fault, carries weekly payments to 104 weeks, and its treatment and care are not measured in weeks at all. They continue while they remain reasonable and necessary. For a condition that often needs a long course of therapy rather than a short one, that last sentence is the whole difference.
The amounts themselves taper. Ninety-five per cent of your earnings shortfall applies through the first 13 weeks. From week 14, and out to week 78, the rate becomes 80 per cent for someone who has lost their earnings altogether and 85 per cent for someone earning something. The insurer’s own clocks are worth knowing too: it must tell you whether it accepts liability for statutory benefits in the first 52 weeks within four weeks, and whether it accepts liability for benefits after the first 52 weeks within nine months.
Source: Motor Accident Injuries Act 2017 ss 3.6, 3.7, 3.11, 3.28 and 6.19. Checked September 2026.
5. Our psychologists work from the same file as our doctors
When our doctor assesses you after a crash, the psychological side is part of that assessment rather than a separate errand you are sent on later. If our psychologists then take over that part of your care, they are reading the same file: the same account of the collision, the same examination findings, the same record of what your physical injuries are doing to your sleep and your work. You are not required to tell the story from the beginning to each new person, which for a trauma presentation is not a small mercy.
It also makes the paperwork coherent. The treatment request that goes to the insurer describes one injured person rather than two unrelated problems, the goals reference the same return-to-work plan, and where a physical injury and a psychological injury are feeding each other, that is written down as the clinical reality it is. If your crash also involved a head injury, read our concussion page alongside this one, because the two overlap and are treated differently.
6. Who writes your certificate
The certificate rules are the same here as they are for a fractured wrist. Something has to be in place for every period you claim weekly payments for, no single one may run longer than 28 days, and the opening certificate is reserved to a treating doctor. From the second onwards the Guidelines allow a doctor, a treating physiotherapist or a treating psychologist to sign it.
For psychological injury that second rule is genuinely useful. Capacity for work after a psychological injury is about concentration, tolerance of pressure, sleep and whether the commute itself is the obstacle, and the person best placed to describe those is the one who has just spent an hour with you. Our Certificate of Fitness guide sets out the form and the timing in full.
Source: SIRA, Motor Accident Guidelines 4.68 and 4.69; Motor Accident Injuries Act 2017 s 3.15. Checked September 2026.
7. When recovery is likely to be delayed
The Guidelines take psychological factors seriously as a cause of slow recovery, and they say so in operational terms. Where recovery is likely to be delayed because of psychological impacts, an insurer is to use rehabilitation providers with expertise in managing psychological injury wherever possible. Separately, an insurer must screen for the risk of poor recovery within three business days of a claim being lodged, taking into account recent information from treating medical practitioners.
Around that sits your recovery plan. Every claimant is to have a tailored recovery plan, completed within 28 days of the claim being made and reviewed at least every 12 weeks, and it must take into account the information your treating providers give. You can be asked to nominate a treating medical practitioner who takes part in developing and delivering it, and a medical practice may be nominated for that purpose rather than a single named doctor. None of this happens usefully if the insurer has nothing recent from anyone treating you, which is the practical argument for being in care rather than waiting to see whether it lifts on its own.
Source: SIRA, Motor Accident Guidelines 4.83, 4.87, 4.90, 4.92, 4.93, 4.97, 4.99 and 4.105. Checked September 2026.
8. Getting an appointment
The timing rules apply to psychological injury exactly as they apply to a broken bone, and they are easy to miss when there is nothing visible to prompt anybody. Police notification has a 28-day window. So does the lodgement that preserves back-dated weekly payments: lodge inside 28 days and the weeks before your claim are payable, lodge after that and they are not. The outer limit for making a statutory benefits claim at all is 3 months from the accident. Inside that first month an insurer may also fund one GP consultation and two allied health treatment sessions before any claim exists, at its own discretion.
To start, call us or book online. Our doctors assess you and write the first certificate, and our psychologists take the treatment from there, with our physiotherapists involved where a physical injury is part of the same picture. Our job is the clinical one: assess you, treat you, and keep the record straight. If a legal question arises we will say so and point you towards a partner law firm rather than answer it ourselves. You can also see how the treatment funding decisions are made on our treatment approvals page, or start with our car accident injury service.
Source: SIRA, Guide for people injured in a motor vehicle accident; SIRA, Motor Accident Guidelines 4.78 and 4.79; Motor Accident Injuries Act 2017 s 6.13. Checked September 2026.