Understanding threshold injury
From 1 December 2017, if you sustain an injury because of a crash, then what you can claim depends on whether your injury is classified as a threshold injury or not.
You can also download a PDF factsheet of this information.
The following information explains what is and is not a threshold injury in the NSW CTP scheme and how it is determined. It also provides information on what to expect, advice on how to recover and what to do if you don’t agree with the insurer’s decision.
What is a threshold injury?
This depends on the diagnosis of your injury. It is not based on symptoms and does not reflect the physical or emotional impact the injury might be having on you.
Most people with a threshold injury are likely to:
- recover well with treatment
- manage their symptoms independently or with some support in place
- recover at work or return to usual activities within a short time.
There are two types of threshold injury:
1. Soft tissue injury
These are injuries to the soft tissues of your body, like your muscles. These types of injuries are common throughout your life. Chances are you have had a soft tissue injury in the past, like a muscle strain or a sore back.
The most common soft tissue injury after a crash is a whiplash injury, which often results in neck pain.
2. Threshold psychological or psychiatric injury
After being involved in, or witnessing, a crash, you may experience some changes in your mood and behaviour. Feelings of sadness, anxiety, fear, anger or guilt are not uncommon.
These types of emotions and psychological symptoms following a crash are classified as a threshold psychological or psychiatric injury.
While the length of time these emotions last will vary for each person, evidence shows most people start to feel better soon, make a good recovery and are able to recover at work or return to usual activities within a short period of time.
In general, if the injury is not a recognised psychiatric illness, it is a threshold injury. However, there are two psychiatric illnesses that are threshold injuries: adjustment disorder and acute stress disorder. These are also injuries where people usually make a good recovery within a short period of time and can recover at work or return to their usual activities.
What benefits are available for people with a threshold injury?
People with a threshold injury may obtain benefits to support their recovery for up to 52 weeks after the crash. The benefits may include:
- weekly income support payments
- medical and treatment expenses
- domestic and personal care services.
What can I expect while I recover?
Everyone responds differently after a crash. It is important to know that experiencing some emotional reactions as you recover does not mean that there is something wrong with you.
Experiencing symptoms such as pain as you recover from an injury does not mean that further damage is being done. You may need to change the way you work or do your usual activities whilst you recover.
Access to support or treatment from health professionals such as medical doctors, psychologists or physiotherapists may be helpful and assist in a faster recovery.
You should check with your doctor to see what is best for you.
What can I do to help myself recover?
The good news is that there is a lot you can do to take charge of your recovery:
- stay positive – positive thoughts can help lift your mood
- stay as active as your doctor recommends
- focus on staying at or returning to work or usual activities
- look after yourself – eat healthy, drink plenty of water and get enough sleep
- talk to family and friends about your progress and how they can help
- pace yourself as you stay active.
Most people find that staying at work assists their recovery, even if they can’t do all their usual tasks.
Your doctor can discuss your recover at work options with you, your employer and insurer.
If you were not working at the time of the crash, staying active and resuming your usual activities also helps your recovery.
For more information, visit the Injury Advice Centre.
When is an injury not a threshold injury?
An injury is not a threshold injury when it does not meet the criteria for soft tissue or threshold psychological or psychiatric injury.
Examples of non-threshold physical injuries may include fractures; nerve injuries; complete or partial rupture of a tendon, cartilage, meniscus or ligament; or damage to the spinal nerve root that meets the criteria for radiculopathy.
Examples of non-threshold psychological or psychiatric injuries may include a diagnosed psychological or psychiatric illness such as depression or post-traumatic stress disorder (PTSD); or any other psychological or psychiatric illness defined in the latest edition of the 'Diagnostic and statistical manual of mental disorders', except for adjustment disorder and acute stress disorder.
Frequently asked questions
Who diagnoses the injury?
Your doctor or treating health professional diagnoses the injury.
Who decides whether the injury is threshold or not?
The insurer must decide whether an injury is a threshold injury after taking into consideration many factors including the assessment by your treating doctor or health professional.
The insurer will let you know how your injury has been classified in a ‘liability notice letter’ outlining the reasons for the decision. They must do this within nine months of your claim being lodged.
You may contact the insurer for more information about the decision or ask any questions.
What if I have multiple injuries?
The insurer will separately classify each crash-related injury.
If all your injuries are threshold, it is a threshold injury claim.
If at least one of your injuries is not a threshold injury, it is not a threshold injury claim.
What if you don’t agree with the insurer’s decision?
If you don’t agree with the insurer’s decision, you may ask the insurer to reconsider it via an ‘insurer internal review’. If you want to request this, you must do so within 28 days of receiving the liability notice letter. You should provide the insurer with any new information you have regarding your injury.
The insurer internal review will be conducted by a person with the required skills, experience, knowledge and training, who did not have a role in the original decision. It may result in the decision being changed.
If you are not satisfied with the outcome of the insurer internal review, you may apply to SIRA’s Dispute Resolution Service to help resolve the dispute.
For more information see motor accidents injury disputes.
Where can I get help?
- Visit the SIRA website www.sira.nsw.gov.au
- See your doctor or health professional
- Contact the insurer’s claims manager
- Find out about Support services to help injured people
- Call CTP Assist – an information service provided by the State Insurance Regulatory Authority – on 1300 656 919.