Threshold injury: information for GPs in the NSW CTP scheme
Significant changes were made to the compulsory third party (CTP) Green Slip scheme in NSW on 1 December 2017 with the commencement of the Motor Accident Injuries Act 2017. The goal of the scheme is to provide prompt treatment and support to everyone injured in a NSW motor accident. The legislation defines some injuries as a ‘threshold injury’.
General Practitioners (GPs) play a critical role in the recovery and well-being of people injured in a motor accident. This factsheet explains what is considered a threshold injury within the scheme, and gives information to help you deliver care to patients injured in a motor accident.
How does the legislation define a threshold injury?
The definition of a threshold injury in the 2017 scheme reflects injuries where most people achieve a sustainable recovery within a short period of time. Threshold injury is defined in the legislation as:
- soft tissue injuries
and/or
- threshold psychological or psychiatric injuries.
Examples of threshold injuries
Examples of injures which are considered threshold are physical injuries such as whiplash, and threshold psychological or psychiatric injuries, such as feelings of sadness, anxiety, fear, anger or guilt; as well as adjustment disorder and acute stress disorder.
Examples of injuries which are not threshold injuries
Examples of injuries which are not considered threshold are any fracture, or complete or partial rupture of a tendon, cartilage, meniscus or ligament.
Who determines if an injury is considered threshold?
The insurer makes the assessment based on the available medical evidence as to whether an injury meets the definition of a threshold injury under the Act. The insurer’s assessment is based on:
- diagnosis, including in the certificate of fitness you provide
- supporting medical information.
The insurer must determine within nine months of the lodgement of a claim whether an injury or injuries meets the definition of a threshold injury in the 2017 CTP scheme.
How can you assist your patients and their insurer?
You do not need to do anything different from your usual practice, other than share information with the insurer. It is important to:
- communicate clearly with your patient, the insurer and other health practitioners - for example, by including a diagnosis in the certificate of fitness rather than general terms, such as ‘stress’ or ‘pain’
- base your diagnosis on your usual clinical practices and objective clinical signs
- use the clinical framework for the delivery of health services to manage your patient’s recovery
- make an early referral to appropriate treatment, including counselling if needed
- ensure the directions you give in the certificate of fitness, relating to capacity for work and activities, are consistent with your patient’s condition and are based on the requirements of their work role
- encourage your patient to stay active in their usual activities, as appropriate, including by discussing the health benefits of good work if they are employed
- understand and accurately apply the diagnostic criteria used to determine diagnosis, with special consideration to the diagnosis of whiplash injuries (referring to SIRA’s acute whiplash guidelines), radiculopathy (section 5.8-5.10 of the Motor Accident Guidelines) and psychological injuries (section 5.11-5.13 of the Motor Accident Guidelines)
- be aware of the expectations of working in the NSW CTP scheme.
Benefits of the scheme for patients with threshold injuries
The scheme encourages early, appropriate treatment to achieve optimum recovery. Regardless of who was at fault in the accident, patients with threshold injuries may obtain benefits to support their recovery for up to 26 weeks after the accident. This may include:
- weekly income support payments
- medical and treatment expenses
- domestic and personal care services.
More information and help
- Treatment information for you
- Whiplash guidelines
- Motor Accident Guidelines
- Threshold injury information for your patient: Understanding threshold injury
- Recovery information for the injured person: Injury Advice Centre
- CTP Assist, SIRA's support and advisory service: 1300 656 919 or [email protected]
- Expectations of working in the scheme