Threshold injury vs non-threshold injury (NSW CTP)
In NSW CTP claims, insurers often raise “threshold injury” because it can affect how long statutory benefits are payable. A separate concept is whether an injury is non-threshold (sometimes called “above-threshold”).
Non-threshold injury ≠ WPI > 10%. WPI (whole person impairment) and the 10% threshold is a separate entitlement test.
- Threshold injury (s 1.6): soft tissue injury and/or non-recognised psychological/psychiatric injury (subject to regulations/guidelines).
- Non-threshold injury: any injury that is not a threshold injury.
- WPI > 10%: a separate impairment threshold used for certain entitlements.
Key point: non-threshold injury is not determined by a WPI percentage. Non-threshold injury ≠ WPI > 10%.
What counts as a threshold injury (Motor Accident Injuries Act 2017 s 1.6)
At a high level, threshold injury includes soft tissue injury and certain psychological/psychiatric injury that is not a recognised psychiatric illness, as defined in s 1.6 and modified by any applicable regulations/guidelines.
Insurers may classify injuries as threshold injuries to apply benefit duration rules. The correct classification is evidence-driven.
What counts as a non-threshold injury (above-threshold injury)
Non-threshold injury is any injury that is not a threshold injury. Depending on the facts and medical evidence, examples may include fractures, nerve injuries, ruptures, and recognised psychiatric illness.
The label is not about severity alone — it is about whether the injury meets the defined threshold injury criteria.
What this classification changes in practice
- Duration of statutory benefits (weekly payments and treatment), depending on your circumstances.
- Dispute pathways (threshold injury disputes are commonly medical disputes).
If your weekly payments have been reduced or stopped, see weekly payments stopped.
Evidence that usually matters most
- Contemporaneous GP/hospital records and objective findings
- Specialist reports addressing diagnosis and criteria
- Imaging where relevant (and clinical correlation)
- Functional evidence over time
Evidence should be targeted to the legal definition — volume alone rarely helps. For each disputed insurer point, identify the exact record that answers it.
How PIC usually decides threshold injury disputes
Threshold injury disputes are commonly determined through the NSW Personal Injury Commission medical pathways.
What to do in the first 14 days after an adverse insurer decision
The first two weeks usually decide whether your threshold classification challenge is evidence-led or merely argumentative. A short, precise specialist brief often makes the difference between a useful report and a generic one.
- 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.
Frequently asked questions
- What is a threshold injury (MAI Act s 1.6)?
- Under the Motor Accident Injuries Act 2017 (NSW) s 1.6, a threshold injury includes a soft tissue injury and/or a psychological or psychiatric injury that is not a recognised psychiatric illness (subject to regulations and guidelines).
- What is a non-threshold injury (above-threshold injury)?
- A non-threshold injury is any injury that is not a threshold injury. Examples can include fractures, nerve injuries, ruptures, and recognised psychiatric illness, depending on the evidence and how the definitions apply.
- Is non-threshold injury the same as WPI > 10%?
- No. Non-threshold injury ≠ WPI > 10%. These are separate legal concepts used for different entitlement questions.
- What does the threshold injury classification affect?
- Threshold injury classification can affect the duration of statutory benefits (weekly payments and treatment). The exact impact depends on your circumstances and insurer decisions.
- How are threshold injury disputes decided?
- Threshold injury disputes are commonly determined through the NSW Personal Injury Commission medical pathways, based on the medical evidence and the applicable definitions/guidelines.