Over-Threshold (Non-Threshold) Injury: Unlocking Your Full Entitlements
In the NSW CTP scheme, injuries are classified as either "threshold" or "non-threshold" (often called over-threshold). This classification is the single most important factor in determining the long-term value of your claim and how long your benefits will last. General information only.
Quick answer
In the NSW CTP scheme, injuries are classified as either "threshold" or "non-threshold" (often called over-threshold). This classification is the single most important factor in determining the long-term value of your claim and how long your benefits will last. General information only.
Why this guide is structured this way
This page is written to help NSW CTP claimants understand deadlines, evidence, insurer decisions, and dispute pathways in plain language without overstating outcomes.
General information only. Your position depends on your facts, evidence, insurer response, and applicable time limits.
Top questions answered
What does "over-threshold" mean in NSW CTP?
It means your injuries do not fall into the "threshold injury" category (formerly minor injuries). This typically refers to physical injuries like fractures or nerve damage, or recognized psychiatric illnesses.
Why is an over-threshold determination important?
If your injury is non-threshold, you are entitled to statutory benefits (weekly payments and treatment) beyond 52 weeks, and you may be eligible to make a claim for common law damages.
How do I prove my injury is over the threshold?
You need specific medical evidence, such as specialist reports, imaging (MRI/CT scans), and clinical findings that satisfy the legal definitions under the Motor Accident Injuries Act 2017.
What is a Non-Threshold Injury?
Under Section 1.6 of the Motor Accident Injuries Act 2017, a threshold injury is limited to soft-tissue injuries and "minor" psychological injuries. Any injury that does not fit that narrow definition is considered "non-threshold".
Common examples of over-threshold injuries include:
- Fractures and broken bones.
- Nerve root compression (radiculopathy).
- Complete ligament or tendon ruptures.
- Traumatic brain injuries.
- Recognized psychiatric illnesses (like PTSD or Major Depression).
The 52-Week Cliff
If your injury is classified as a "threshold injury", your weekly income support and medical treatment payments will usually stop after 52 weeks. If your injury is classified as "non-threshold", these benefits can continue as long as you meet the other criteria.
Eligibility for Common Law Damages
You are only permitted to make a claim for a lump sum "common law damages" settlement if you have a non-threshold injury. This is a critical gateway. Without an over-threshold determination, your claim is limited to statutory benefits only.
Disputing the Insurer’s Decision
Insurers often classify injuries as "threshold" even when there is evidence to the contrary. If you disagree with the insurer’s classification, the strongest response usually does more than say the injury feels serious. It identifies the exact diagnosis, body-system, and evidence issues the insurer has overlooked.
- You usually need a focused Internal Review request tied to the actual insurer reasons.
- If the insurer does not change the decision, the matter may need to be escalated to a Personal Injury Commission medical pathway.
- Where the dispute overlaps with WPI, settlement timing, or damages access, it also helps to separate those issues rather than blending everything into one generic submission.
That is why many over-threshold disputes also connect to guidance on threshold injury disputes, PIC stream selection, and the broader WPI / 10% threshold pathway.
Evidence issues that usually matter most in over-threshold disputes
A stronger non-threshold case is usually built around issue-specific medical and functional evidence, not just repeated complaints of pain. Depending on the injury, the material that most often matters includes:
- specialist diagnosis and examination findings that show why the injury falls outside the threshold definition
- imaging, operative notes, or nerve findings that support fracture, radiculopathy, rupture, brain injury, or other recognised non-threshold categories
- consistent GP, specialist, rehab, and certificate records showing the same injury story over time
- functional evidence explaining how the injury affects work capacity, treatment needs, and day-to-day activity
- insurer decision letters, IME reports, and review correspondence so each disputed point can be answered directly
If damages may later be in issue, it is also sensible to preserve the separate evidence needed for non-economic loss, future treatment, and earnings impact rather than assuming the threshold dispute alone will do all the work.
Common mistakes when people try to prove a non-threshold injury
- relying on generic treating letters that do not address the legal threshold classification issue
- assuming significant pain automatically means the injury must be non-threshold
- mixing threshold arguments with unrelated weekly-benefit, treatment, or PAWE disputes so the key medical issue gets blurred
- failing to challenge insurer IME reasoning point by point
- settling or making damages assumptions before the gateway issue is properly resolved
These mistakes often weaken both the immediate classification dispute and the later damages pathway. Pages on settlement timing and WPI assessment can help you understand the downstream impact.
First 14 days after an insurer says your injury is still threshold
The first two weeks after an adverse threshold decision are usually where over-threshold disputes are either stabilised or weakened. A practical sequence is to:
- obtain the full decision record (including IME rationale, clinical assumptions, and insurer reasoning), not just a summary statement
- separate the dispute into diagnosis, causation, classification, and functional impact so your response does not blur key gateway issues
- map targeted medical and functional evidence to each disputed point instead of filing a generic support letter
- prepare an internal review package that can be lifted into a PIC pathway with minimal rework if needed
This approach usually improves both immediate classification outcomes and downstream readiness for damages, WPI, and non-economic loss strategy.
Why you should contact us immediately
The difference between a threshold and non-threshold injury can be worth hundreds of thousands of dollars over the life of a claim. If the insurer has called your injury "minor" or "threshold", contact us immediately to discuss a dispute. We can help gather the specific medical evidence needed to cross this gateway and plan the next steps for review, PIC escalation, and damages readiness.
Frequently asked questions
- What does "over-threshold" mean in NSW CTP?
- It means your injuries do not fall into the "threshold injury" category (formerly minor injuries). This typically refers to physical injuries like fractures or nerve damage, or recognized psychiatric illnesses.
- Why is an over-threshold determination important?
- If your injury is non-threshold, you are entitled to statutory benefits (weekly payments and treatment) beyond 52 weeks, and you may be eligible to make a claim for common law damages.
- How do I prove my injury is over the threshold?
- You need specific medical evidence, such as specialist reports, imaging (MRI/CT scans), and clinical findings that satisfy the legal definitions under the Motor Accident Injuries Act 2017.
- Can I prove an over-threshold injury only by showing WPI above 10%?
- No. Threshold classification and WPI percentage are separate legal tests. You should first prove why the injury is non-threshold on diagnosis/evidence grounds, then run WPI and damages evidence on a separate track.
- How quickly should I challenge a threshold decision?
- Move quickly and work from the deadline stated in your insurer decision notice and the applicable PIC pathway rules. Do not assume every dispute has the same timeframe.
- What if the insurer relies on the threshold guidelines but ignores fracture, radiculopathy, or rupture evidence?
- That is usually a point-specific review problem, not just a disagreement about pain. The response should identify the exact diagnosis and objective evidence the insurer or IME has failed to deal with, then tie that material back to the legal classification issue in the internal review and, if needed, the PIC medical pathway.
- Should I discuss settlement before the threshold issue is resolved?
- Usually only with caution. If threshold status is still disputed, early settlement discussions can undervalue future entitlements. It is generally safer to stabilise the gateway issue first and then negotiate with clearer damages positioning.
- What if the insurer accepts a fracture or tear but says the remaining symptoms are only soft tissue?
- That can still be a live non-threshold dispute. The issue is not whether you also have soft-tissue symptoms; it is whether the accepted diagnosis, imaging, operative findings, or neurological signs place the injury outside the threshold definition. The response should separate the recognised non-threshold pathology from any secondary soft-tissue complaints and force the insurer to address both properly.
- Should I panic if I can still do short tasks on some days?
- No. Being able to complete a short activity once or twice does not automatically make your injury threshold. Insurers and decision-makers usually look for sustained function over time, reliability, symptom rebound after activity, and whether you need extra rest, pacing, or treatment to get through ordinary weeks.