Threshold injury vs non-threshold injury (NSW CTP)

Section 1.6 defines threshold injury as a soft-tissue injury or a psychological or psychiatric injury that is not a recognised psychiatric illness. Regulation clause 4 adds that acute stress disorder and adjustment disorder are threshold injuries, and that a spinal nerve-root injury with neurological signs other than radiculopathy remains within the soft-tissue definition. Part 5 of the Motor Accident Guidelines governs the medical assessment.

Insurers may classify injuries as threshold injuries to apply benefit duration rules. The correct classification is evidence-driven.

Non-threshold injury is any injury outside that definition. Depending on the facts and medical evidence, examples may include fractures, nerve injuries, a complete or partial rupture of a tendon, ligament, meniscus or cartilage, and a recognised psychiatric illness other than acute stress disorder or adjustment disorder. A diagnostic label does not remove the need to establish accident causation.

The label is not about severity alone — it is about whether the injury meets the defined threshold injury criteria.

A threshold injury decision is important because it can influence the practical value and direction of the claim before any final damages assessment. It should be checked against the actual diagnoses, the insurer’s reasons, the Motor Accident Guidelines, and the medical material the insurer relied on.

• Weekly payments: if the insurer relies on threshold injury to limit or stop statutory benefits, review the decision against capacity evidence, PAWE assumptions, and the threshold reasoning.
• Treatment expenses: threshold classification can affect how long reasonable and necessary treatment is funded, especially where the insurer says the injury remains soft tissue only.
• Evidence strategy: useful material usually identifies the actual diagnosis, mechanism, clinical signs, imaging correlation, functional restrictions, and whether the condition falls outside the threshold definition.
• Dispute pathway: threshold injury disputes are commonly handled as medical disputes, while related payment or procedural issues may require internal review or a different PIC pathway.

If your weekly payments have been reduced or stopped, see weekly payments stopped. If treatment has been refused, see treatment refused in NSW CTP.

The strongest threshold injury challenge is usually diagnosis-led, not adjective-led. Saying an injury is “serious” is less useful than showing why the diagnosis, objective signs, or psychiatric criteria do not fit the threshold definition.

• Contemporaneous ambulance, emergency department, GP and physiotherapy records showing symptoms from the accident onward.
• Specialist reports that identify the diagnosis and explain why it is or is not only soft tissue injury.
• Imaging, nerve studies, operative notes or injection records where they are clinically relevant, with a doctor explaining their significance.
• Psychiatric or psychological reports that address whether there is a recognised psychiatric illness, not only distress symptoms.
• Functional evidence over time, including work capacity certificates and treatment response, where it helps explain the injury pathway.
• The insurer’s medical examination (IME) report and any factual assumptions that may need correction.

Evidence should be targeted to the legal definition, volume alone rarely helps. For each disputed insurer point, identify the exact record that answers it. Related guides: IME preparation, WPI assessment, and threshold injury guidelines.

This section explains why radiculopathy evidence can move a spinal injury dispute away from a simple soft tissue classification. Under the Motor Accident Guidelines, radiculopathy is not proved by pain alone or by imaging alone. The practical checkpoint is whether at least 2/5 clinical signs support the same nerve-root distribution.

The five signs are reflex loss or asymmetry, positive sciatic nerve-root tension signs, qualifying atrophy or reduced limb circumference, anatomically localised muscle weakness, and reproducible anatomically localised sensory loss. Table 6.8 defines the measurement method for atrophy. The signs must fit the relevant nerve-root distribution.

A stronger evidence bundle links the accident chronology, early symptoms, imaging, treating notes and specialist examination to the insurer's exact reasoning. Radiating pain, non-verifiable sensory complaints and a disc bulge on imaging do not satisfy the two-sign test by themselves.

Threshold injury disputes are commonly determined through the NSW Personal Injury Commission medical pathways. The issue is usually framed around the statutory definition, the Motor Accident Guidelines, and the medical evidence, not around whether the claimant is generally deserving or still in pain.

Before PIC escalation, check whether an internal review is required or strategically useful, whether the insurer has supplied the documents relied on, and whether any medico-legal report directly answers the disputed classification. A concise chronology can help connect the accident mechanism, early records, later investigations, treatment history and current diagnosis.

Read: Personal Injury Commission (PIC), PIC merit review vs medical assessment, and threshold injury dispute pathway.

Read the decision date, reasons, medical material relied on and review-rights section together. Use the review period stated in the decision and obtain advice promptly if the date is unclear, close or already passed.

• Extract every insurer finding in writing (diagnosis, mechanism, psychiatric characterisation, and guideline references).
• Request and organise the full claim file set: clinical records relied on, surveillance notes (if any), and medico-legal reports.
• Map each disputed finding to targeted evidence gaps before filing internal review.
• When briefing specialists, give them the insurer’s exact disputed sentence so reports answer the real legal issue, not just the diagnosis label.
• Prepare escalation materials early in case the matter proceeds to PIC medical assessment.

Practical next steps: internal review strategy, threshold injury dispute pathway, and PIC merit vs medical stream selection.