What to do if your CTP treatment request is disputed
A full walkthrough of what counts as a dispute, why insurers decline psychology treatment requests, what evidence helps, the actual Personal Injury Commission review path for CTP claims, and when a medico-legal assessment happens.
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 motor accident scheme has a defined, free review process built into it, separate from the courts. This guide walks through what actually counts as a dispute, why insurers decline psychology requests, what helps your case, the real Personal Injury Commission review path, and when a medico-legal assessment comes into it.
What counts as a "dispute"
In the CTP scheme, a dispute is any disagreement between you and the insurer about a decision on your claim. For someone seeing a psychologist, the most common version is a declined or partly declined Allied Health Treatment Request (AHTR): the form your psychologist submits explaining the treatment they want to provide and why. Other disputes can cover whether your injury is a threshold or non-threshold injury (which affects how long benefits last), whether you were mostly at fault, or the amount of a weekly payment. This guide focuses on treatment disputes, since that is what stops people getting to their sessions.
A dispute is not the same as a delay. If the insurer simply has not responded within its 10 working day window (see the insurer quick-reference), the first step is to follow up, not to lodge a formal dispute. A dispute proper starts once the insurer has actually made a decision you disagree with.
Why insurers decline a psychology treatment request
Insurers do not need to prove your distress is not real to decline a request. Declines (and partial approvals) usually come down to one of a few things: the AHTR does not yet show enough detail linking your current symptoms to the accident specifically, rather than to other life stress or a pre-existing condition; the insurer is not yet convinced the proposed treatment is "reasonable and necessary" at this point, for example if it wants to see progress from a first block of sessions before approving more; there is a dispute about whether your injury is a threshold or non-threshold injury, which affects entitlement; or there is a genuine dispute about liability or fault that has not been resolved yet. Sometimes it is simpler than any of that: the request was incomplete, or used an outdated form.
None of these are necessarily the end of your claim. A decline is a decision made on the information in front of the insurer at that point, and it can change once your psychologist provides clearer documentation.
1. Understand exactly what was decided, and why
Ask the insurer for the decision in writing and for its reasons, if you have not already received them. A request is often declined or only partly approved because it needs more clinical information, rather than because it has been refused outright. Keep copies of everything: the AHTR, the decision letter, and any correspondence.
2. Give your psychologist and GP the chance to strengthen the evidence
The single most useful thing you can do is make sure your psychologist's documentation clearly draws the line between the accident and what you are experiencing now: specific symptoms, when they started, how they affect daily life, and why the proposed sessions are expected to help. A GP letter that confirms the same timeline adds weight. If you had a pre-existing mental health history, being upfront about it and explaining how the accident changed things is usually stronger than leaving it out, since insurers can request your Medicare or health records anyway.
If sessions already happened, notes showing progress, or showing why more sessions are still reasonable and necessary, matter more than a general statement that treatment is ongoing.
3. Ask the insurer for an internal review
You can ask the insurer to internally review a decision you disagree with, generally within 28 days of receiving it. This is a fresh look by someone at the insurer who was not involved in the original decision, and it is a normal, expected part of the process, not a complaint that counts against you. Put your request in writing, referencing the decision, and attach any new information from your treating practitioners. Insurers are generally required to respond to an internal review request within a set timeframe (around 14 days) under the Motor Accident Guidelines, though this can vary with the complexity of the matter. There is no cost to you for requesting an internal review.
4. If the internal review does not resolve it: the Personal Injury Commission
This is the part that differs from workers compensation, and it is worth getting right. CTP motor accident disputes are not handled by SIRA's Independent Review Office (IRO), which funds legal costs and reviews complaints for the workers compensation scheme only, and does not currently assist CTP claimants. Motor accident treatment and entitlement disputes go to the Personal Injury Commission (PIC), an independent NSW tribunal, through a merit review application. Most merit review applications need an insurer internal review first, so step 3 above is usually a required stop on the way, not an optional extra.
A merit review looks again at the insurer's decision, including disputes about treatment and care such as psychology, weekly payments, and other statutory benefits. Applications are lodged through the Commission's online platform, and the insurer must respond within a set period once the application is served. The Commission can be contacted on 1800 742 679 (Monday to Friday, 8:30am to 5:00pm) for guidance on how to apply. There is no cost to lodge a merit review application.
Free help while you go through this
You do not have to navigate a dispute alone or pay for advice to get started. SIRA's CTP Assist team (1300 656 919, [email protected]) is a free information service for anyone with a motor accident claim, and can point you to the right form and process. Separately, the CTP Legal Advisory Service is a panel of independent lawyers who give free, confidential legal advice over the phone to people injured in a motor accident, arranged through CTP Assist. LawAccess NSW (1300 888 529) is a free general government legal information and referral line that also covers motor accident questions. None of these services are run by this directory, and none of them are the insurer.
When a medico-legal assessment happens
A medico-legal (or independent medical) assessment is different from ongoing treatment. Instead of your treating psychologist, it is carried out by an independent medical examiner, often a psychiatrist or another appropriately qualified mental health assessor, whose role is to give an opinion for the claim, not to treat you. These assessments tend to come up in a few situations: when there is a genuine dispute about the nature or extent of a psychological injury, when your injury's threshold classification is contested, or when whole person impairment needs to be assessed for a further claim. The Personal Injury Commission can arrange or direct an independent medical examination as part of resolving a dispute.
It is normal to feel anxious about an assessment that is not with your own psychologist. It usually involves a longer, structured interview about the accident, your history, and your current symptoms, sometimes with questionnaires. Being clear and consistent about your timeline and symptoms, the same information your treating psychologist already has, is the most useful preparation. Your psychologist or a free legal adviser can tell you what to expect for your specific situation, since the format varies with what is being assessed.
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 (see the cost guide). Continuity of care matters more than which pathway is paying in the short term. A psychologist experienced with the scheme can also help by documenting your presentation clearly for a dispute; a few of the listings in this directory, including practitioners in the Sydney CBD and Eastern Suburbs and Illawarra and regional NSW, focus on assessment and report work.
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
SIRA "Motor crash compensation disputes" (https://www.sira.nsw.gov.au/claims-assistance/motor-crash-compensation-disputes); Part 7 of the Motor Accident Guidelines: Dispute Resolution (https://www.sira.nsw.gov.au/resources-library/motor-accident-resources/publications/for-professionals/motor-accident-guidelines/part-7-of-the-motor-accident-guidelines); Personal Injury Commission, "Merit review dispute" for the 2017 motor accidents scheme (https://www.pi.nsw.gov.au/types-of-disputes/motor-accidents-2017-scheme/merit-review-dispute); SIRA "Support from CTP Assist" (https://www.sira.nsw.gov.au/claims-assistance/support-from-ctp-assist); SIRA "CTP Legal Advisory Service" (https://www.sira.nsw.gov.au/resources-library/motor-crash-compensation/guides-and-resources/ctp-legal-advisory-service); LawAccess NSW (https://www.lawaccess.nsw.gov.au/); Independent Review Office, "About us", confirming IRO and the Independent Legal Assistance and Review Service (ILARS) cover workers compensation, not CTP claimants (https://www.iro.nsw.gov.au/about-us); SIRA "Allied Health Treatment Request (AHTR)" (https://www.sira.nsw.gov.au/health-providers/allied-health-treatment-request-ahtr). Dispute pathways and timeframes are administered under the Motor Accident Injuries Act 2017 (NSW) and can change; confirm the current process and time limits with SIRA, the Personal Injury Commission, or a free legal service.