The response of a ship or other vessel to surface sea waves, including extreme waves, may compromise crew and vessel safety and long-term operational capability. Herein, a novel high-fidelity numerical time-dependent simulation approach is presented using Smoothed Particle Hydrodynamics (SPH) for modelling sea waves coupled with Finite Element Analysis for modelling vessel structural response under wave loading conditions. The results are compared with physical scale model wave tank test results. Good agreement was obtained for heave and pitch motions and vertical bending moments for various forward (head) speeds in regular head waves, heave and pitch motions, and vertical bending moments. High computational demands can be met by the increasing availability of computation power. Ongoing research is outlined. The implications for the design of vessels such as ships and for through-life assessment are discussed.