What to do if your CTP treatment request is disputed
Practical steps if the insurer declines or delays funding your psychology sessions, including free help and independent review.
It is disheartening to be told a treatment request has been declined or is stuck, especially when you are already unwell. A dispute is not the end of the road, though. The NSW scheme has free help and independent review built into it. Here is a calm, practical order of steps.
1. Understand exactly what was decided
Ask the insurer for the decision in writing and for the reasons. Sometimes a request is declined because it needs more clinical information showing the treatment is reasonable and necessary and linked to the accident, rather than because it was refused outright. Your GP and psychologist can often provide that supporting detail. Keep copies of everything.
2. Ask for an internal review
You can usually ask the insurer to internally review a decision you disagree with. This is a fresh look at the decision by the insurer, and it is a normal part of the process, not a complaint that counts against you. Put your request in writing and include any new information from your treating practitioners.
3. Use the free independent services
NSW provides independent help outside the insurer. SIRA's Independent Review Office (IRO) and dispute-resolution services, and the Personal Injury Commission, exist to resolve motor accident disputes independently, and there are free advisory and legal services for people navigating claims. These services are there precisely because insurers and injured people sometimes disagree. Because this directory is not a legal service, getting this independent help for a genuine dispute is the right move.
A psychologist experienced with the scheme can also help by documenting your presentation clearly, and in some cases an independent psychological-injury assessment (separate from your treating psychologist) is used in contested claims. A few of the listings in this directory focus on that kind of assessment and report work.
4. Look after yourself while it is sorted
Disputes take time, and your wellbeing should not be on hold in the meantime. If funding is delayed, ask your GP about a Mental Health Treatment Plan and Medicare rebates as an interim way to keep seeing a psychologist. Continuity of care matters more than which pathway is paying in the short term.
This guide is general information, not legal, medical, or crisis advice. If you are struggling right now, you do not have to wait: Lifeline is on 13 11 14, Beyond Blue is on 1300 22 4636, 13YARN (for Aboriginal and Torres Strait Islander people) is on 13 92 76, and in an emergency call 000.
Sources
State Insurance Regulatory Authority (SIRA) guidance for people injured in motor accidents (https://www.sira.nsw.gov.au/resources-library/motor-accident-resources/publications/injury-advice-centre/guide-for-people-injured-in-motor-accidents-in-nsw); SIRA Motor Accident Guidelines: CTP Care (https://www.sira.nsw.gov.au/resources-library/motor-accident-resources/publications/for-professionals/motor-accident-guidelines-ctp-care). Dispute and review pathways (internal review, Independent Review Office, Personal Injury Commission) are administered under the Motor Accident Injuries Act 2017 (NSW); confirm the current process and time limits with SIRA or a free legal service.