Overview
How this affects your claim in practice
A diagnosed psychological condition may be claimed where it develops as a consequence of an accepted or compensable physical injury, its pain, disability, treatment or loss of function. This is a secondary psychological injury, not a primary psychological injury caused directly by work events. The medical evidence should explain the physical-to-psychological causal sequence and resulting treatment or incapacity.
The post-1 July 2026 eligibility pathway for primary psychological injury must not be imposed on a consequential secondary condition. Secondary psychological impairment is also not separately assessed for section 66 WPI, although treatment and weekly-payment consequences may still require a liability decision. Psychological symptoms alone do not prove a diagnosed consequential injury.
- The new post-1 July 2026 primary-injury gateway does not apply to secondary psychological injury.
- The evidence should link the physical injury and its consequences to the later condition.
- Functional evidence matters where symptoms affect treatment, rehabilitation or sustainable work.
- Insurers may dispute causation by pointing to employment, financial, family or pre-existing factors.
- Secondary psychological impairment is excluded from permanent impairment assessment.
- The condition may still be relevant to treatment, weekly payments and damages evidence.
Practical review
What to check in this situation
- Document the accepted physical injury, later psychological onset, diagnosis and the clinician’s causal reasoning.
- Keep the secondary condition separate from a primary work-event psychological claim and from ordinary distress or pain.
- Seek written liability and treatment decisions without adding secondary psychological WPI to physical WPI.
Records that may help
Keep physical-injury acceptance, pain and treatment chronology, first psychological presentation, GP and mental-health reports, Certificates of Capacity, treatment requests and insurer scope decisions.
Next procedural step
Notify the diagnosed condition with focused medical evidence and ask for a written decision; obtain advice if the insurer applies the wrong primary-injury gateway or refuses treatment.
How a secondary condition may develop
Examples include depression after chronic back pain limits mobility and work, anxiety after an unsuccessful shoulder operation, or adjustment disorder after a knee injury prevents a return to a physical occupation. These are illustrations, not automatic legal conclusions.
The medical history should identify when symptoms began, how they changed with pain, treatment and capacity, and whether other causes contributed. A treating practitioner should explain the relationship rather than simply repeat the worker’s belief.
Work capacity and treatment
A worker may be physically capable of isolated light tasks yet unable to sustain reliable attendance because of poor sleep, fatigue, concentration problems, anxiety, low mood or pain-related distress. Capacity evidence should describe hours, pace, interaction, travel, supervision and likely symptom flare-up.
A request for psychology or psychiatry treatment should identify the condition, connection to the physical injury, proposed treatment, functional goals and why the treatment is reasonably necessary. The insurer may accept the physical injury while disputing the psychological condition or the treatment request.
- Current and earlier certificates of capacity.
- GP, psychologist and psychiatrist notes and reports.
- Pain specialist, surgeon and rehabilitation records.
- Medication history and side effects.
- Failed suitable duties or graded return-to-work attempts.
- Statements describing functional change, used as support rather than a substitute for medical evidence.
Common insurer disputes
A useful response matches each insurer reason with the chronology and relevant evidence. It should not hide other stressors or overstate what one report proves.
- The condition is said to arise from personal or financial stress rather than the physical injury.
- The early medical notes do not record psychological symptoms.
- The diagnosis or treatment request is said to lack adequate clinical support.
- The worker is said to have physical capacity and therefore sustainable capacity for work.
- A later employment conflict is said to be the true cause, raising classification or Section 11A issues.
- Symptoms are said to be inconsistent with activity, rehabilitation or surveillance material.
Permanent impairment and work injury damages
Section 65A provides that no permanent impairment compensation is payable for secondary psychological injury. Secondary symptoms are not added to a physical WPI rating and are not included in a primary psychological WPI rating.
That does not make the condition irrelevant to every other issue. If a worker otherwise meets the applicable work injury damages requirements, consistent evidence about psychological symptoms may be relevant to capacity, reliability, retraining and future economic loss. It does not automatically increase damages or satisfy a threshold.
Three practical illustrations
| Physical injury history | Claim issue |
|---|---|
| Back injury with chronic pain and depression | Whether sleep, fatigue and concentration make proposed suitable duties unsustainable. |
| Shoulder injury, surgery and anxiety | Whether treatment and failed rehabilitation evidence connect the condition to the physical injury. |
| Knee injury and adjustment disorder | Whether loss of a physical occupation affects retraining, labour-market reliability and damages evidence. |
Each example requires its own medical causation evidence. It is not a prediction that liability, treatment or payments will be accepted.
Official sources
Sources are listed for transparency. This guide is general information only and is not legal advice.
- SIRA - psychological injury claims for workers and employers
- SIRA - current psychological injury guidance for insurers
- Workers Compensation Act 1987 (NSW), including section 65A and the earlier provisions
- Workers Compensation Legislation Amendment Act 2025 No 72 (NSW), as made
- SIRA - NSW permanent impairment assessment guidelines
Frequently asked questions
What is a secondary psychological injury?
It is a psychological injury arising as a consequence of another work-related condition, most commonly a physical injury.
Can it affect weekly payments?
It can if reliable evidence explains how the condition affects sustainable work capacity and links it to the work-related physical injury.
Can psychological treatment be claimed?
Treatment may be payable where it is connected to the compensable injury and reasonably necessary, but the insurer may dispute the diagnosis, causal connection or treatment need.
Can it be included in WPI?
No. Section 65A excludes permanent impairment compensation for secondary psychological injury and excludes those symptoms from physical and primary psychological impairment assessments.
What if an employment dispute also contributed?
The direct workplace events and physical-injury consequences may need separate analysis. The applicable Section 11A wording and claim framework should be checked rather than assumed.
Does the 2026 primary psychological injury reform apply?
SIRA states that the new primary-injury rules do not apply to secondary psychological injury. Other current or transitional provisions may still affect the claim.
Need the physical and psychological evidence reviewed together?
Send the accepted injury details, insurer decision, certificates, treating reports and return-to-work history so the actual causation, treatment and capacity issues can be identified.