A plain explanation of what a threshold injury is in a New South Wales motor accident claim and how it affects statutory benefits and a claim for damages.
A threshold injury is the label the New South Wales motor accident scheme gives to a soft tissue injury, such as whiplash, or a minor psychological injury. It matters because it limits the statutory benefits you can receive, and it closes the door to a claim for damages unless the classification is changed.
The label is not always the end of the matter. It is a starting classification, and it can be challenged through a defined dispute process.
What counts as a threshold injury
The Motor Accident Injuries Act 2017 defines a threshold injury in two parts. The first is a soft tissue injury, which is damage to muscles, tendons or ligaments. Common examples are neck and back strains and whiplash associated disorders at the milder end of the scale. The Act excludes more serious structural injuries, so a complete or partial rupture of a tendon or ligament, a fracture, a dislocation, or an injury to a nerve root or the spinal cord is not a threshold injury.
The second part is a minor psychological or psychiatric injury. This means an injury that does not amount to a recognised psychiatric illness. A diagnosed psychiatric illness sits outside the threshold category, except for the diagnoses of an Adjustment Disorder and Acute Stress Disorder.
Everything else is a non threshold injury. Our glossary entry on a non threshold injury gives the short version.
How the classification is made
In the first instance the insurer makes the decision. It looks at the medical certificates, your treatment records and the history of the accident, and it decides whether the injury fits the definition. SIRA, the State Insurance Regulatory Authority, publishes guidelines that insurers must follow, and the diagnosis recorded by your treating doctors carries real weight.
This is why the early medical record matters. A vague entry such as neck pain can lead to a soft tissue label, while a precise diagnosis supported by examination findings or imaging can change how the injury is classified. The insurer may also ask you to attend an examination with a doctor it chooses. Our FAQ on the insurer medical examination explains what to expect.
What remains available if you have a threshold injury
Statutory benefits are available without proof of fault, and a threshold injury does not remove them. The difference is the length of time they run.
| Threshold injury | Non threshold injury | |
|---|---|---|
| Treatment and care benefits | Available for a limited period set by the Act | Can run for longer, subject to the scheme rules |
| Income support | Available for a limited period set by the Act | Can run for longer, subject to the scheme rules |
| Claim for damages | Not available | Available if you were not mostly at fault |
The limited period is set by the legislation and runs from the date of the accident, so it is a strict timeframe. We have not set it out here because it can change and because the details depend on your circumstances. Whether any benefits continue beyond that period depends on the classification of your injury, which is why a dispute about it can matter.
Fault also plays a part. The scheme treats a person who was mostly at fault differently, and the two questions of fault and injury classification interact. Our guide to CTP claims in New South Wales explains how the two stages fit together.
How a claim for damages differs
A claim for damages is a separate step from statutory benefits. It is assessed on fault, and it is open only to a person who was not mostly at fault and whose injury is a non threshold injury. If the insurer accepts that your injury is a threshold injury, a damages claim is not available on that classification.
For that reason the classification is often the central question in a New South Wales motor accident file. A claimant with a soft tissue label and ongoing symptoms may find that the whole claim turns on whether the label is correct.
If you disagree with the classification
You can raise a dispute. The usual path begins with a request to the insurer to review its decision. If you are still unhappy, the matter can be taken to the Personal Injury Commission. Depending on the issue, the dispute may be treated as a merit review of the insurer’s decision or sent to a medical assessor, who considers the medical evidence and gives an opinion on the nature of the injury.
Each step has strict timeframes set by the regulator. Missing a step can limit your options, so seek advice promptly if you receive a decision you do not agree with.
A medical assessor works from the evidence in front of them. Treating doctor reports, imaging, and a clear account of your symptoms and their effect on work and daily life all form part of that evidence. No one can promise how a dispute will turn out, and a threshold classification may be upheld.
The difference with Tae & Partners is that we are willing to communicate and work with your treating doctors, so that you are properly diagnosed, receive the correct treatment and overcome the threshold injury dispute.
Time limits still apply
Whatever the classification, the scheme has strict timeframes for notifying the insurer and for bringing a claim for damages. See our FAQ on time limits for personal injury claims for the general picture.
What to do next
If you have been told your motor accident injury is a threshold injury, start by asking the insurer for its decision in writing and the reasons for it. Keep a record of your treatment, your symptoms and any time off work, and ask your treating doctor to record a precise diagnosis.
Then get advice promptly, because disputing a classification is subject to strict timeframes. Try our claim check for a quick sense of where you stand, or contact us to talk through your options.