Non-threshold injury in NSW CTP claims
In the NSW CTP scheme, an injury is either within the statutory threshold definition or outside it. “Over-threshold” is informal wording for a non-threshold injury. The classification can affect benefits and damages pathways, but it is separate from WPI and does not guarantee an entitlement or outcome. General information only.
Key points to check
Use these points to match the guide to the document or issue you are dealing with.
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?
A non-threshold classification may allow statutory benefits to continue beyond limits that apply to threshold injuries and is a gateway for a possible common law damages claim. Continued benefits and damages still depend on the other statutory requirements and evidence.
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?
Section 1.6 of the Motor Accident Injuries Act 2017 defines threshold injury as a soft-tissue injury or a psychological or psychiatric injury that is not a recognised psychiatric illness, subject to Regulation clause 4. An injury outside that definition is commonly described as non-threshold.
Examples that may be non-threshold when medically established and caused by the accident include:
- Fractures and broken bones.
- Nerve injury or radiculopathy that satisfies the Part 5 clinical-sign test.
- Complete or partial rupture of a tendon, ligament, meniscus or cartilage.
- Traumatic brain injuries.
- A recognised psychiatric illness, subject to diagnosis and causation. Acute stress disorder and adjustment disorder remain threshold under Regulation clause 4.
How the classification can affect statutory benefits
A threshold classification can limit the duration of weekly payments and treatment and care benefits. A non-threshold classification may keep a longer statutory-benefits pathway open, but payments do not continue automatically: fault provisions, work capacity, treatment necessity, statutory cessation rules and other requirements may still apply.
Eligibility for Common Law Damages
A non-threshold injury is a gateway for a possible common law damages claim, but it is not the whole test. Fault, causation, economic loss, the separate damages claim form and applicable time limits must also be addressed. Greater than 10% WPI is specifically relevant to non-economic loss; it is not the test for whether an injury is non-threshold.
Disputing the Insurer’s Decision
If you disagree with an insurer’s threshold classification, the response should do more than say the injury feels serious. Identify the exact diagnosis, statutory definition, body-system findings and evidence the decision has not addressed.
- 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.
What to do after an insurer says the injury is threshold
Read the decision date, reasons, evidence relied on and review rights together. 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.
When legal advice may help
Legal advice may be useful where the decision affects weekly payments, treatment, a PIC medical dispute or a possible damages pathway. Send the insurer decision and the key medical evidence so the classification issue, review date and next step can be checked without assuming an outcome.
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?
- A non-threshold classification may allow statutory benefits to continue beyond limits that apply to threshold injuries and is a gateway for a possible common law damages claim. Continued benefits and damages still depend on the other statutory requirements and evidence.
- 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.
Assessment source
Which rules define a non-threshold injury?
Assessment source: Motor Accident Injuries Act 2017 (NSW), sections 1.6-1.7; Motor Accident Injuries Regulation 2017, clause 4; Motor Accident Guidelines Part 5, clauses 5.1-5.12; Table 6.8 where radiculopathy is in issue.
Threshold injury: Non-threshold means the injury falls outside the section 1.6 threshold definition. It does not mean WPI is greater than 10%, and it does not automatically establish statutory benefits or damages.
What the assessor checks
- A nerve injury and a complete or partial rupture of a tendon, ligament, meniscus or cartilage are excluded from the Act's soft-tissue definition.
- Neck or spine radiculopathy requires two or more qualifying clinical signs under clauses 5.8 and 6.138.
- Acute stress disorder and adjustment disorder are expressly threshold injuries under Regulation clause 4.
- Other recognised psychiatric illnesses still require diagnosis and accident-causation evidence; the label alone is not enough.
- WPI is assessed separately under Part 6, and greater than 10% is specifically relevant to non-economic loss.
What does not establish the result by itself
- Pain severity, time off work or treatment intensity without a diagnosis outside the threshold definition.
- A disc bulge or radiating pain without the required radiculopathy signs.
- Surgery or a psychiatric label without evidence of the actual injury and accident causation.
- A WPI estimate used as a substitute for threshold classification.