Understanding PTSD & other psychological injury claims for first responders

First responders do some of the toughest jobs in Australia — and the mental toll can be just as real as the physical risks. If you’re struggling with PTSD or other psychological injuries due to work, navigating the Comcare system can feel overwhelming. But knowing a few key things can make all the difference in getting the help and compensation you deserve.

At TGB Lawyers, we’ve spent decades helping first responders – especially police, military members, nurses, paramedics and others  – with their claims under the Comcare scheme.

We are going to share with you some of the pitfalls you might encounter along the way, and how best to avoid them.

Is the current system working for first responders?

Short answer: not really.

The Safety, Rehabilitation and Compensation Act (SRCA) – which underpins the Comcare scheme – came into effect in 1988 and hasn’t had a major overhaul since. That’s a problem, because it was designed for a very different workforce to what exists in 2025.

Over that same period, the State-based work injury schemes have all introduced totally new schemes and laws.

To be frank, the SRCA is an outdated Act which prejudices first responders who inevitably become injured in the course of their work, when they are assisting others in an often traumatic set of circumstances.

The PTSD presumption – a step forward

There’s one recent change that’s actually a big help for first responders.

From 15 December 2023, if you’re diagnosed with PTSD, it’s automatically presumed to be work-related… unless Comcare can prove otherwise. That includes situations where existing PTSD is already present prior to December 2023 but has been made worse by something work-related that occurred after that date.

This presumption can be a game changer, but timing matters. Some questions to ask include:

• When did you first get treated?
• When did you start taking time off work?
• What date did your doctor say the condition began?

Even if the event that triggered PTSD happened before December 2023, you might still qualify if symptoms or treatment didn’t start until later. Obtaining legal advice about how this might apply to your situation is critical, as it could be pivotal and beneficial in your case.

When filing a claim less is more

One of the biggest mistakes we see? Over-explaining.

People understandably want to tell their whole story – but in a claim, long emotional statements can actually harm your case. Comcare may latch onto irrelevant details or use parts of your statement in a way that is detrimental to your claim.

Instead, stick to the basics:

• Focus on the key event (or events) that caused your injury.
• Use clear, simple language – no opinions, no emotion.
• Keep it short.
• Stick to the facts.

This approach helps keep the focus where it belongs: on the injury and the evidence.

Medical evidence matters – a lot

The success of your claim often hinges on what your doctor says. Ideally, you need a GP or specialist who’s willing to back you up with solid medical reports.

Be aware that:

• Comcare can (and often does) seek second or third opinions if they don’t like the first one.
• Your medical notes, including those from psychologists are not confidential. Comcare can request them, so always be thoughtful about what you share.

Psychological claims are tough – here’s why

Around 12% of all Comcare claims are psychological – but for first responders, that number is likely higher. And they’re harder to get accepted.

Why? One big hurdle is the “reasonable administrative action” (RAA) rule. Under the SRCA, if your injury was caused by something like a performance review, denial of a promotion, or a disciplinary process – even if it was stressful – it might not be covered.

Add to that the fact that psychological claims often involve disputes over what actually happened, and it’s easy to see why many claims fail.

To boost your chances:

• Avoid relying on RAA-related events in your statement.
• Get short, clear witness statements if they are factual disagreements.
• Stick to clear, work-related causes that fall outside the RAA.

What if your claim is rejected?

You’re not out of options.

If Comcare rejects your claim:

• You can ask for a reconsideration – a simple email explaining why you disagree.
• If that doesn’t work, you can appeal to the Administrative Review Tribunal (ART).
• Most cases are resolved through negotiation, not hearings. The process usually takes 6 – 12 months.
• If you win, Comcare usually covers most (or all of) the legal fees.

What happens if your claim is accepted?

If your claim is accepted, there are three main types of compensation. These are:

1. Incapacity payments – If you can’t work (or can only work reduced hours), you may receive payments close to your usual wage. After 45 weeks, payments will reduce by 25%.
2. Medical expenses – This covers treatment like GP visits, surgery, medication, therapy, physio, and it’s payable for life, as long as it relates to your injury and is reasonable.
3. Permanent impairment – If your injury is long-term, you might be entitled to a lump sum payment of compensation. This payment is tax-free.

To sum up …

Psychological injury claims are complex. The system isn’t perfect – especially for first responders – but with the right advice and a careful approach, there are real options available.

If you’re unsure where to start, or if you’ve already hit roadblocks, we’re here to help. You don’t need to go through it alone.

To help give you the best chance, get in contact with us today!

T: 1800 730 842

E: twhite@tgb.com.au

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