SIRA Workers Compensation/CTP
Supporting Recovery and Resilience After Trauma
Psychological injuries can occur after distressing events at work, such as bullying, harassment, accidents, or chronic stress. They can also arise following motor vehicle accidents or other incidents covered under CTP (Compulsory Third Party) insurance. These experiences can leave people feeling unsafe, anxious, or “stuck” in patterns of distress that don’t improve with time alone.
EMDR (Eye Movement Desensitisation and Reprocessing) and Flash Technique can be used to help clients process and recover from these experiences in a structured, evidence-based way. EMDR is recommended by international trauma guidelines (World Health Organization) and recognised by Medicare for treating posttraumatic stress and other conditions. Other responses to injury may include, Acute Stress Disorder, Adjustment Disorder, Anxiety and Panic Related to Workplace Triggers, Moral Injury and Betrayal Trauma, Vicarious or Secondary Trauma, Workplace Bullying and Harassment, Trauma-Related Chronic Pain and diminished self-worth.
Applications in Workplace and CTP Contexts
EMDR can be used to address:
- Workplace bullying, harassment, or conflict
- Occupational trauma (e.g., emergency services, healthcare, or first responders)
- Motor vehicle or transport accidents
- Witnessing or being involved in a workplace incident or injury
- Chronic stress or burnout with trauma-related features
Clients often report improvements not only in symptoms such as anxiety, nightmares, or intrusive thoughts, but also in self-confidence, concentration, and overall wellbeing.
EMDR can be effectively delivered via secure telehealth sessions. This allows clients to access care from the comfort of their own home, while maintaining all the safety and structure of in-person therapy. The approach is gentle and paced to ensure clients remain grounded and supported throughout the process.
Understanding the different types of psychological work injuries
Post-Traumatic Stress Disorder (PTSD)
Think of PTSD as a Fear-Based Injury. It’s an alarm system that gets stuck in the “ON” position after a severe threat.
The Event: Usually results from one or a few terrifying, life-threatening events, where you or someone else faced actual or threatened death, or serious injury
Examples: Car accident, natural disaster, an assault, or a violent event.
- The Core Response (The Symptoms): Your brain focuses on Safety and Threat.
- Re-experiencing: You have flashbacks or nightmares where you feel like the danger is happening right now.
- Hyperarousal: You’re constantly on edge, easily startled (jumpy), and always watching for danger (hypervigilance).
- Avoidance: You try to avoid places, people, or thoughts that remind you of the trauma.
- The Core Belief: “The world is unsafe,” or “I am in danger.”
Complex Post-Traumatic Stress Disorder (CPTSD)
Think of CPTSD as an Injury to the Self, caused by prolonged harm. It’s not just an alarm stuck on; it’s a personality and identity shaped by constant danger.
The Event: Results from long-term, repeated, and inescapable trauma— directly or involving betrayal by someone who should have protected you.
Examples: Chronic child abuse or neglect, long-term domestic violence, human trafficking, or living in a war zone for years.
- The Core Response (The Symptoms): You have the core PTSD symptoms (flashbacks, avoidance, hyperarousal) PLUS three additional, deep-seated issues:
- Emotion Regulation: You struggle to control intense emotions (like sudden, intense anger or sadness).
- Negative Self-Concept: You have deep feelings of shame, guilt, or worthlessness (“I am bad,” “I am broken”).
- Relationship Problems: You have severe difficulty trusting people or maintaining stable, meaningful relationships.
- The Core Belief: “I am permanently damaged,” or “No one can be trusted.”
Moral Injury
Think of Moral Injury as a Conscience Injury. It’s not a formal mental health diagnosis like PTSD or CPTSD, but a profound spiritual and psychological distress.
The Event: Results from a “Potentially Morally Injurious Event” (PMIE) that violates your deepest beliefs about right and wrong. It may or may not be physically life-threatening. The injury is to your moral code.
Examples:
- Act of Commission: Doing something you believe is wrong (e.g., perpetrating an act of violence).
- Act of Omission: Failing to do something you should have done (e.g., freezing or failing to intervene to help a victim).
- Betrayal: Being betrayed by a leader or institution you trusted (e.g., a manager covering up abuse).
- The Core Response (The Emotions): The key feelings are centered on morality and justice.
- Guilt: I did something bad.
- Shame: I am a bad person.
- Anger and Betrayal: Losing faith in others, leaders, or even a higher power.
- Isolation: Feeling unworthy of love or healing, leading to withdrawal.
- The Core Belief: “I am unforgivable,” or “The world is not just.”
You may experience one or a combination of these injuries and all can present with symptoms consistent with PTSD. All of these injuries feel traumatic.
It may be useful to be aware that the diagnosis on your claim may be listed as
Adjustment Disorder, if there was no identified life-threatening event. Where this continues once the stressor or its consequences have terminated, the diagnosis may evolve to Mixed anxiety and depression.
1. Eligibility for Primary Psychological Injury Claims
- The injury was directly caused by a legally specified “relevant event” (or series of events), such as workplace violence, serious criminal conduct, witnessing a traumatic incident, vicarious trauma, sexual or racial harassment, bullying, or excessive work demands.
- There is a direct causal link between the event and employment, with employment determined to be the main contributing factor.
- General workplace stress or everyday interpersonal friction without a qualifying relevant event does not meet the statutory criteria for a primary claim.
If you lodged your psychological claim after 1 July 2026, the insurer must confirm that your condition was caused by specific workplace events—like bullying, trauma, harassment, or unmanageable work demands—and that work was the primary cause. General work stress alone no longer qualifies for a primary claim. Note: If your psychological distress was caused as a result of a physical workplace injury (a secondary psychological condition), these new restrictions do not apply to you.
2. Reasonable Management Action
If your distress came from normal, fair workplace management—like receiving constructive performance feedback, undergoing a business restructure, or standard disciplinary steps—it is generally protected by law and won’t be covered by workers compensation. However, if management actions were unfair, unreasonable, or crossed into workplace bullying or harassment, your claim can still be considered.
3. Disputed Misconduct Claims & The Industrial Relations Commission (IRC)
- The Industrial Relations Commission (IRC) acts as a factual gateway to determine whether the alleged conduct occurred.
- While an IRC application is being processed, injured workers are eligible to receive up to $7,500 in provisional medical treatment support and interim weekly payments to ensure psychological support is not delayed.
- Once the IRC confirms the factual occurrence of the conduct, the matter moves to the Personal Injury Commission (PIC) to resolve compensation entitlements.
If your claim is based on bullying, harassment, or severe overwork and your employer disputes what happened, a specialized court (the IRC) investigates the facts first. While this investigation takes place, the insurer must cover up to $7,500 in medical and therapy costs so you can continue getting psychological help without waiting for the dispute to finish.
4. Assessment Standard for Psychological Therapy
- Directly treat the primary compensable injury.
- Be clinically justified and evidence-based (following SIRA Allied Health guidelines).
- Demonstrate functional benefits, focusing on symptom management, daily functioning, and return-to-work capacity.
For your therapy sessions to be approved and paid for by the insurer, your psychologist needs to submit formal treatment plans (AHTRs) showing that the care is directly helping your recovery. The insurer looks for therapies that are proven to work, give you real-life coping tools, and help you return to daily activities or work safely.
5. Ongoing Entitlements & Whole Person Impairment (WPI)
- Weekly Benefits (Beyond 130 Weeks): To receive weekly benefits past 2.5 years (130 weeks), primary psychological injury claims must meet a minimum statutory threshold of 25% WPI.
- Medical Funding: Approved medical and psychological treatment can generally continue for up to 12 months after weekly financial benefits cease (unless assessed with a WPI over 30%, which grants lifelong medical funding).
- Lump Sum Compensation: Access to permanent impairment lump-sum compensation remains at 15% WPI.
Workers compensation covers weekly wage support and psychological therapy while you recover. If you need support past 2.5 years (130 weeks), an independent medical specialist must assess your overall permanent impairment. Even after weekly wage payments end, your therapy sessions can usually continue for another 12 months to support your transition.
Exempt Worker Categories
How to Lodge a Primary Psychological Injury Claim & Access Treatment
- Navigating a work-related psychological injury can feel overwhelming. Following the 2026 NSW Workers Compensation Scheme updates, the State Insurance Regulatory Authority (SIRA) established a clearer, streamlined process to help you access early medical care while your claim is lodged and assessed.
1. Notify Your Employer & Seek Medical Care: Initial Injury Reporting.
- Statutory Rule: Notify your manager, HR department, or employer of the psychological injury as soon as practicable after it occurs or when you first become aware of it. Seek medical attention from a General Practitioner (GP) or treating doctor.
- SIRA Certificate of Capacity: Your GP must complete an official SIRA Certificate of Capacity. This document outlines your diagnosis, identifies whether the condition is work-related, and states your current capacity for work or modified duties.
Tell your employer as soon as you realise your mental health has been impacted by work. Next, visit your GP. Your doctor will assess you and fill out a specific medical form called a “Certificate of Capacity” that officially records your diagnosis and how it affects your ability to work.
2. Lodge the Claim with the Insurer: Formal Claim Submission.
- Statutory Rule: A formal claim is lodged by submitting your SIRA Certificate of Capacity and a completed Worker’s Injury Claim Form to your employer or directly to their workers compensation insurer (e.g., icare or a specialized/self-insurer).
- SIRA Notification Window: Once notified, the insurer must contact you and your employer within 3 business days to acknowledge receipt and outline the next steps.
Send your completed claim form and your GP’s Certificate of Capacity to your manager, HR, or directly to the workers compensation insurer. By law, the insurer must reach out to you within 3 business days to confirm they have received your paperwork and explain what happens next.
3. Access Early Medical Treatment (Provisional Support): Provisional Care Funding.
- Statutory Rule: Under SIRA guidelines, insurers are required to support early intervention. Before formal liability is formally accepted or denied, insurers can approve provisional medical support (covering reasonable medical and psychological treatment expenses) to ensure treatment is not delayed.
- For Misconduct Disputes (IRC Gateway): If your claim involves disputed allegations of workplace misconduct (e.g., bullying, harassment, or excessive workload), you are entitled to up to $7,500 in provisional treatment funding while the Industrial Relations Commission (IRC) evaluates the factual details.
You don’t have to wait for the insurer to make a final decision on your claim before getting help. Insurers can pay for initial medical appointments and psychology sessions upfront under “provisional care.” Even if your employer disputes a bullying or overwork claim, you can access up to $7,500 in provisional therapy funding so your treatment can start straight away.
4. See an Approved Psychologist & Submit an AHTR: Treatment Plan Approval.
- Statutory Rule: Schedule an intake with a SIRA-approved psychologist. To continue receiving funded treatment past initial sessions, your psychologist submits an Allied Health Treatment Request (AHTR) to the insurer.
- Reasonable and Necessary Standard: The request must satisfy SIRA’s “reasonable and necessary” standard by outlining evidence-based interventions (such as CBT or EMDR) and clear SMART goals targeting functional recovery and return-to-work capacity.
Book an appointment with a SIRA-approved psychologist. Your psychologist will assess your needs and send a treatment proposal (called an AHTR) to the insurer. The insurer reviews this to make sure the proposed therapy sessions are proven to work, directly related to your injury, and focused on helping you feel better and resume daily activities.
5. Insurer Liability Determination: Claim Assessment.
- Statutory Rule: Within 21 days of receiving your claim, the insurer must issue a formal determination:
- Accept Liability: Ongoing weekly payments, medical treatment, and psychological support are formally approved.
- Dispute / Decline Liability: If liability is declined or disputed (via a Section 78 Notice), the insurer must explain the legal reasons (e.g., asserting “reasonable management action” or lack of a “relevant event”).
- Dispute Pathways: If disputed, your psychologist can continue providing care under provisional funding where applicable, while you access free legal representation via an IRO Approved Lawyer to resolve the dispute through the IRC or Personal Injury Commission (PIC).
Within 21 days, the insurer will write to you with their decision. If accepted, your weekly wage support and therapy sessions continue seamlessly. If they dispute your claim, they must give you clear written reasons. If that happens, you can get free help from an IRO-approved workers compensation lawyer to appeal the decision, while your provisional treatment continues to support you.
- Statutory Rule: If liability is accepted (or while provisional payments continue), the insurer creates a tailored Injury Management Plan (IMP) in consultation with you, your GP, and your treating psychologist. Psychological therapy continues under pre-approved Allied Health Treatment Requests (AHTRs) submitted by your treating practitioner.
- AHTR Blocks & Frequency: Under SIRA guidelines, each AHTR typically requests a block of 4 to 8 sessions (depending on claim stage and insurer requirements). Treatment frequency is tailored to your clinical recovery stage:
- Acute / Stabilization Phase: more frequent consultations to establish coping strategies, manage acute distress, and process primary trauma targets using evidence-based interventions (such as CBT, EMDR, or Flash Technique).
- Consolidation / RTW Phase: Fortnightly to monthly consultations as you build self-management skills, apply workplace strategies, and transition back to work or daily activities.
- Evaluation Standard: The insurer evaluates each request under the “reasonable and necessary” standard. Your psychologist must include Standardised Outcome Measures (such as the DASS-21, PCL-5, or WSAS) to demonstrate measurable functional progress before a subsequent block of sessions can be approved.
- Capacity Reviews: Your GP updates your SIRA Certificate of Capacity at least every 28 days to record your functional progress and work capacity.
Once your claim is up and running, the insurer works with your health team to set up a plan for your recovery. To keep your treatment going, your psychologist submits an Allied Health Treatment Request (AHTR) form to the insurer to request approval for blocks of therapy (typically 4 to 8 sessions at a time depending on your plan).
At the start of therapy, sessions are usually scheduled more frequently to help stabilize your symptoms, build coping skills, and work through traumatic workplace incidents. As you improve and get closer to returning to work, sessions taper to fortnightly or monthly to focus on self-management and maintaining your gains.
Before approving a new block of sessions, the insurer reviews tracking tools and questionnaires completed during your therapy to confirm that the sessions are continuing to help you make real functional progress. Meanwhile, your GP reviews your health every 4 weeks to update your medical certificate.
7. Internal Review & IRO Legal Assistance: Navigating Disputed Claims.
Statutory Rule: If the insurer declines liability or refuses a specific treatment request (issuing a Section 78 Notice), you have the right to request an Internal Review directly with the insurer.
Independent Review Office (IRO): You can access free legal representation by contacting an IRO Approved Lawyer. The lawyer applies for grant funding through the Independent Legal Assistance and Review Service (ILARS) to investigate your dispute, gather independent medical evidence, and represent you at zero out-of-pocket cost.
If the insurer rejects your claim or refuses to pay for further therapy sessions, you can ask them to re-examine their decision. You don’t have to fight this alone: you can hire a specialized workers compensation lawyer through the Independent Review Office (IRO). The lawyer’s fees and independent medical reports are funded by the government, meaning you pay nothing out of pocket.
8. Commission Resolution (IRC or PIC):Formal Dispute Pathways.
Statutory Rule: If the internal review does not resolve the dispute, your approved lawyer will lodge an application with the relevant formal dispute body:
Industrial Relations Commission (IRC): For disputes involving workplace misconduct, harassment, bullying, or excessive demands (“relevant conduct”), the IRC evaluates the evidence to issue a binding determination on whether the conduct occurred.
Personal Injury Commission (PIC): For all other disputes (or once the IRC confirms conduct occurred), the PIC conducts conciliation or arbitration hearings to issue legally binding orders regarding liability, medical expenses, and weekly benefits.
If the insurer still refuses your claim after an internal review, your lawyer takes the matter to a specialized tribunal. If your claim involves bullying or workplace harassment, the Industrial Relations Commission (IRC) investigates the facts first. Otherwise, the Personal Injury Commission (PIC) steps in to hold a hearing and make a final, legally binding decision on whether the insurer must cover your treatment and wages.
9. Work Capacity Reviews & Return to Work (RTW): Safe Return to Work.
Statutory Rule: When clinically appropriate, your psychologist, GP, and workplace rehab provider collaborate with your employer to develop a Return to Work (RTW) Plan. Employers are legally required to provide suitable duties where reasonably practicable.
Work Capacity Decisions: Insurers perform periodic reviews of your capacity for work. Any proposed change to your weekly payments must be notified with a formal notice period.
As your mental health improves, your treating team helps plan a gradual, safe return to work. This might mean starting with reduced hours, modified duties, or working in a different team or environment. Your employer must make reasonable adjustments to help you return safely.
10. Permanent Impairment & Claim Conclusion: Long-Term Entitlements & Closure.
Statutory Rule: If you experience long-term, permanent psychological symptoms despite completed treatment, your lawyer can arrange a Whole Person Impairment (WPI) assessment by an accredited medical specialist:
15% WPI or higher: Grants access to statutory lump-sum permanent impairment compensation.
25% WPI or higher: Entitles primary psychological injury claims to extend weekly benefits past 130 weeks (2.5 years) and unlocks access to common law Work Injury Damages.
Treatment Extension: Medical and psychological treatment expenses generally continue for 12 months after your weekly financial payments end.
If your work injury leaves you with long-lasting mental health impacts, a specialist doctor can assess your level of permanent impairment. Reaching specific thresholds opens up lump-sum compensation or extended financial support past 2.5 years. Even after weekly wage support stops, approved therapy sessions can usually continue for up to another year to support your long-term wellbeing.
Who is Involved in Your Claim? Roles & Key Priorities
1. The Nominated Treating Doctor (GP)
- Primary Role: Oversees your general medical care, issues official SIRA Certificates of Capacity, and acts as the medical gateway for specialists and treatment referrals.
- Key Priorities:
- Diagnosing medical conditions and assessing overall health.
- Issuing updated 28-day Certificates of Capacity detailing your current work capacity and medical restrictions.
- Evaluating treatment progress and authorizing medication or specialist referrals.
Your GP is your primary medical guide. They evaluate your mental and physical health, complete your regular medical certificates, and work with your psychologist to ensure your overall treatment plan is safe and effective.
2. The Treating Psychologist (Allied Health Practitioner)
- Primary Role: Delivers evidence-based psychological therapy (such as CBT, EMDR, or Flash Technique) to treat your compensable injury, reduce symptoms, and restore daily functioning.
- Key Priorities:
- Submitting Allied Health Treatment Requests (AHTRs) to secure insurer funding for therapy blocks.
- Administering standardized outcome measures (e.g., DASS-21, PCL-5, WSAS) to monitor and demonstrate objective progress.
- Equipping you with practical coping mechanisms, trauma processing tools, and workplace transition strategies.
Your psychologist is your dedicated mental health treatment provider. They focus on helping you process traumatic workplace events, reduce emotional distress, and build practical skills so you can feel better in daily life and return to work safely.
3. The Insurer Case Manager
- Primary Role: Manages the administration of your claim on behalf of the scheme (e.g., icare, EML, Allianz, QBE, or a self-insurer), evaluating liability and funding entitlements.
- Key Priorities:
- Determining claim liability and issuing formal determinations (e.g., Section 78 notices).
- Approving “reasonable and necessary” medical expenses, therapy requests (AHTRs), and weekly income benefits.
- Developing the formal Injury Management Plan (IMP) and monitoring overall claim milestones.
The case manager works for the insurance company handling your claim paperwork. Their job is to review medical reports, approve treatment funding, pay weekly wages if you are off work, and ensure all statutory requirements are met.
4. The Employer (Managers / HR / Return to Work Coordinator)
- Primary Role: Maintains workplace safety, reports work injuries, and provides suitable duties to support your recovery at work.
- Key Priorities:
- Fulfilling statutory duties to accommodate medical restrictions listed on your Certificate of Capacity.
- Developing a tailored Return to Work (RTW) plan offering suitable, safe duties.
- Ensuring a safe workplace environment free from unmanaged risks, bullying, or hazards.
Your employer is legally obligated to support your recovery. If your doctor certifies that you can work modified hours or lighter duties, your employer must make reasonable adjustments to help you work safely while you recover.
5. Workplace Rehabilitation Provider (WRP)
- Primary Role: An independent occupational specialist (e.g., occupational therapist, rehabilitation counselor, or psychologist) appointed by the insurer to assist with workplace assessments and return-to-work planning.
- Key Priorities:
- Conducting workplace assessments to evaluate the psychological and physical demands of your job.
- Mediating between you, your employer, and your treating team to design a gradual Return to Work plan.
- Identifying alternative vocational options if returning to your previous role is not clinically advisable.
If returning to work is complex, the insurer may appoint a workplace rehabilitation specialist. They act as a neutral bridge between you, your employer, and your treating team to make sure your work duties are safe and matched to your current capacity.
6. Approved Legal Representative (IRO Lawyer)
- Primary Role: Provides independent legal representation and advocacy for injured workers navigating claim disputes or liability denials.
- Key Priorities:
- Securing government grant funding through the Independent Legal Assistance and Review Service (ILARS) so legal representation is free to the worker.
- Gathering expert medical evidence and representing you in internal reviews or formal proceedings before the Industrial Relations Commission (IRC) or Personal Injury Commission (PIC).
- Protecting your statutory entitlements regarding weekly benefits, treatment expenses, and permanent impairment assessments.
If the insurer declines your claim or rejects a treatment request, you can engage a specialized workers compensation lawyer. Through government funding (via the IRO), their services and expert reports are provided at no out-of-pocket cost to you.