Posted on 10 Apr 2026

Threshold vs Non-Threshold Injuries in NSW CTP Claims Explained

What is a threshold injury?

A threshold injury is a less serious injury. These injuries were referred to as ‘minor injuries’ before 2023, and you may still hear them called that in older resources.

There are two main types of threshold injuries:

1. Soft tissue injuries

These are injuries to the tissues that connect, support, or surround your bones and organs. In the context of a CTP claim, this includes:

Whiplash and neck strains.
Muscle aches or back pain.
Tears or sprains that are not ‘full-thickness’ ruptures.
Nerve symptoms like tingling or numbness, provided they do not meet the strict legal definition of radiculopathy.

2. Threshold psychological injuries

These include general feelings of fear, anxiety, or sadness that do not meet the criteria for a ‘recognised psychiatric illness’.

If you have a formal diagnosis for your condition, it will generally be considered non-threshold. However, two exceptions are still threshold conditions:

Adjustment disorder.

Acute stress disorder.

Important note: An insurer’s assessment is based on your official diagnosis, not the physical or emotional impact the injury has on your daily life. It is possible to be in significant pain and still be classified as having a threshold injury.

What is a non-threshold injury?

A non-threshold injury is any injury that falls outside the strict, limited definitions of a soft tissue or minor psychological injury. In the eyes of a CTP insurer, this classification means your injuries are serious enough to require extended care.

There are two main categories of non-threshold injuries:

1. Physical non-threshold injuries

To meet this classification physically, there must usually be a disruption to the actual structure of your body, rather than just the surrounding soft tissue. This includes:

Fractures: Any significant fracture or broken bone.
Nerve injuries: Direct damage to the nerves.
Ruptures: A complete or partial rupture of a tendon, cartilage, meniscus, or ligament.
Radiculopathy: Damage to the spinal nerve root. This goes beyond standard back pain or tingling and must meet very specific clinical criteria during a medical exam to cross the line from threshold to non-threshold.

2. Non-threshold psychological injuries

Severe, diagnosed psychiatric illnesses fall into the non-threshold category. These include:

Post-Traumatic Stress Disorder (PTSD).
Major Depressive Disorder.
Severe Anxiety Disorders.
Any other clinical mental health condition recognised in the DSM-5, excluding adjustment disorder and acute stress disorder.

Why the threshold vs. non-threshold label matters

The insurer isn’t just categorising your pain; they are setting a limit on your support. This means that if all your injuries are classified as threshold:

The 52-week cut-off: Your weekly income payments and medical treatment coverage will typically stop exactly one year after the accident.
No lump sum: You are legally barred from pursuing a common law damages claim (a lump sum payout) for pain and suffering or future lost income.

However, the moment your injury is classified as non-threshold, the 52-week cut-off disappears, provided you were not at fault for the accident.

Extended benefits: Your weekly income support and medical treatments can continue for 2 to 5 years.
Lump sum payout: You gain the right to file a common law damages claim. This allows you to sue for a lump sum to cover past and future lost earnings. If your Whole Person Impairment (WPI) is assessed at greater than 10%, you can also claim a lump sum for pain and suffering.

In our experience, insurers routinely classify borderline cases (like disc bulges or severe anxiety) as threshold to save money. Overturning this initial decision with hard medical evidence is often the most important step in a CTP claim.

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How is my level of impairment assessed?

Your GP or treating specialist provides the first medical reports. This includes your symptoms, physical exam findings, and any scans (like MRIs or X-rays).

The insurer’s internal team (and often their own hired doctors) will then review your file. They’re looking for specific non-threshold markers, such as a fracture on a scan or clinical signs of nerve damage.

By law, the insurer must give you a formal injury classification within nine months of you lodging a claim. This is done through a Liability Notice letter (also known as a Section 81 Notice under the SIRA Motor Accident Guidelines).

What if I have multiple injuries?

If you have multiple injuries, the most serious injury dictates the entire claim. While the insurer must assess every injury you sustained in the crash individually, your claim’s overall classification follows these two rules:

Multiple threshold injuries ≠ non-threshold injury: If you have multiple injuries classified as threshold (e.g. whiplash, a minor back strain, and an adjustment disorder), they cannot be added together to secure a non-threshold classification. Your entire claim is still considered a threshold injury claim.
A single non-threshold injury is enough: If you have multiple injuries, you only need one of those to be classified as non-threshold to receive an overall non-threshold classification.

Since a non-threshold classification opens the door to substantially more compensation, it’s s vital to report every symptom to your doctor — no matter how minor it seems at first. A ‘tingle’ in your arm could be the clinical sign of a nerve injury (radiculopathy) that moves your claim from a 52-week cap to a potential multi-year settlement.

What should I do to prepare for my injury assessment?

The insurer decides your classification based on the medical evidence you provide. To ensure they have the full picture, follow these steps:

Detail everything: Ensure every injury (no matter how minor) is listed in your Application for Personal Injury Benefits and your Certificate of Capacity (PDF).
Check medical reports: Review all documents from your GP, specialists, and physiotherapists.
Include aggravations: If the accident made a pre-existing condition worse, this must be documented as a new injury.
Fix omissions: If you notice an injury is missing from a report, ask your doctor to rectify it in their next update. You should also notify the insurer in writing that an injury was omitted from the initial evidence to keep it under consideration.
Attend independent assessments: You may be asked to attend an Independent Medical Assessment if there’s any dispute about your injury or its impact on your life.

What if I disagree with my injury assessment?

The insurer’s decision is not final. If your injuries have been classified as threshold, you have a limited window to challenge that assessment and secure your long-term benefits. Here’s how it works:

Step 1: Insurer internal review

Before escalating the matter, you must usually ask the insurer to reconsider its own decision.

Deadline: You must lodge a request for an internal review within 28 days of receiving your Liability Notice.
Process: A different person within the insurance company (someone not involved in the original decision) will review your file.
Evidence: To give your review the best chance of success, make sure to submit fresh evidence. If you have a new MRI, a report from a specialist, or evidence of a worsening condition, include it here.
Turnaround: The insurer must generally provide a decision within 14 to 21 days.

Step 2: The Personal Injury Commission (PIC)

If the internal review does not change the outcome, you can escalate the dispute to the Personal Injury Commission.

Independent assessment: The PIC will appoint an independent Medical Assessor (a neutral doctor) to examine you.
Binding decision: The assessor will issue a certificate stating whether your injury is threshold or non-threshold. This decision is generally binding on both you and the insurer.

It’s worth noting that the PIC has strict procedural rules regarding the submission of evidence. Even if you handled the original CTP claim alone, we strong getting working with a lawyer for your dispute. We can help you navigate the process and ensure your medical evidence meets the Commission’s standards.

How much compensation can I get?

In NSW, the amount of compensation you receive depends entirely on your injury classification and whether you were at fault.

If your injury is classified as threshold (minor), you are entitled to statutory benefits ‘no-fault” benefits, meaning you can claim them even if the accident was 100% your fault.

Weekly income support: You can receive up to 95% of your pre-injury earnings for the first 13 weeks. From week 14 to 52, this typically drops to 80% or 85%, depending on your ability to work.
Medical treatment: The insurer covers ‘reasonable and necessary’ costs for GPs, specialists, and physio. They usually pay these providers directly.
Care and support: If you need help with domestic tasks like cleaning or gardening, you can claim for paid professional support or care provided by family and friends.

As we’ve discussed, these payments have a strict cut-off time of 52 weeks.

If your injury is non-threshold, your benefits are much more extensive.

Common law damages: This is the most significant difference. You can pursue a common law damages claim if the accident was not your fault. A successful claim can result in a lump sum payout worth hundreds of thousands of dollars (or millions, in severe cases).
Extended income support: Your income support can continue for up to two years, and even up to five years if you make a common law damages claim.
Long-term treatment: Medical and care expenses can be covered indefinitely, provided they remain ‘reasonable and necessary’.

To make a common law damages claim, you must prove the accident was someone else’s fault. There are two types of ‘damages’ you can claim:

Economic loss: This compensates you for the money you’ve lost and will lose in the future, including lost wages and superannuation and future loss of earning capacity (if you can no longer work in your previous role or at the same level).
Pain and suffering: This is a payout for the physical and emotional toll of the accident. To be eligible, your Whole Person Impairment (WPI) must be assessed at greater than 10%. As of 2026, the maximum amount payable for pain and suffering in a NSW CTP claim is $691,000.

Your Situation	What You Can Claim
WPI of 10% or less	Economic losses only: * Past lost income. * Loss of future earning capacity.
WPI over 10%	Economic losses (as above), plus: * Pain and suffering. * Loss of enjoyment of life. * Disfigurement. * Reduced life expectancy.

What is WPI?

WPI is a percentage that measures how much your injury has permanently affected your body or mind. It is assessed by an independent doctor once your condition has ‘stabilised’ (usually 12–18 months after the crash).

Because the difference between 10% and 11% WPI can be worth hundreds of thousands of dollars, these assessments are often the most contested part of a common law damages claim.

Can I get free help with my claim?

Yes, you can get free help from an expert lawyer for a basic CTP claim. In NSW, the law protects claimants by regulating how lawyers can charge for CTP work:

Statutory benefit claims: For the initial ‘no-fault’ part of your claim (weekly payments and medical bills), lawyers are not allowed to charge you a fee. The insurer pays a fixed amount toward your legal costs directly. This means you can get legal advice on your ‘threshold’ status without receiving a bill.
Common law damages: If your injuries are non-threshold and the accident wasn’t your fault, we can handle your claim on a No Win, No Fee basis. This means we cover all upfront costs, and you won’t pay a cent unless your claim is successful.

Keep in mind, if your lump sum claim is successful, the insurer is usually ordered to pay a significant portion of your legal costs on top of your compensation. This means you keep more (if not all) of your total payout.

How a lawyer can help with your claim

When it comes to CTP claims in NSW, getting your injury classified as ‘non-threshold’ is the difference between 52 weeks of support and a lifetime of financial security.

Insurers often default to a ‘threshold’ classification to limit their liability. Here is how an expert lawyer challenges that decision and ensures you get the most possible compensation:

Navigating the ‘grey areas’: Many injuries fall into a grey area where the medical evidence is open to interpretation. We know the specific diagnostic markers (such as the ‘two-sign’ rule for nerve damage) required to upgrade your claim from a simple soft-tissue injury to a non-threshold one.
Representation at the PIC: If the insurer refuses to reclassify your injury after an internal review, the dispute moves to the Personal Injury Commission. We represent during this formal process, preparing the submissions and cross-examining medical reports to ensure an independent assessor sees the full extent of your disability.
Leveraging case law: The definition of an injury changes as new decisions are handed down by the PIC. Because we monitor these cases daily, we can use successful precedents to argue why your specific symptoms legally qualify as non-threshold.
Building strong evidence: We don't just rely on your GP’s reports. Our lawyers work with Independent Medical Examiners who understand the 2026 SIRA guidelines and the American Medical Association’s Guides to the Evaluation of Permanent Impairment. This ensures your medical reports use the exact legal terminology the Personal Injury Commission looks for.