What to Do When the CTP Insurer Says Your Injury Is “Threshold”

If you've just received a letter from your CTP insurer classifying your injury as a “threshold injury”, it's worth understanding exactly what that decision does before you accept it or move on. This one classification affects both how long your statutory benefits run and whether you can pursue common law damages at all.

What “threshold injury” actually means

From 1 April 2023, the NSW scheme replaced the term “minor injury” with “threshold injury”. It's generally a soft tissue injury — to muscles, tendons or ligaments — that doesn't involve nerve damage or a full or partial tear of a tendon, ligament, meniscus or cartilage. A threshold psychological injury is its own related category (see threshold vs non-threshold injury). It's a legal-medical classification, decided by the insurer based on medical evidence, not a description you or your GP simply choose.

Why the letter matters so much

• For accidents on or after 1 April 2023, a threshold injury generally limits statutory benefits (weekly payments and treatment and care) to 52 weeks.
• Common law damages — the lump sum track — generally aren't available for a threshold injury classification, regardless of fault.
• The classification can be based on a single independent medical examination, which may not reflect your treating team's view.

Read the decision closely

Insurers are generally required to explain the basis for the decision. Look for what medical evidence they relied on — was it your treating records, or primarily an independent medical examination arranged by them? If it's based on limited or older evidence, that's a genuine avenue to challenge it.

What to do next

• Get a specialist opinion if you haven't already — a GP note carries less weight on this specific question than a specialist's assessment. A doctor experienced with CTP claims can arrange the referral; see doctors and allied health for CTP claims.
• Check whether your imaging or clinical findings actually show nerve involvement or a structural tear that the insurer may have missed or discounted.
• Note the review deadline — you generally have 28 days from receiving the decision to ask the insurer for an internal review.
• Get legal advice before accepting the classification, particularly if your symptoms feel more significant than “threshold” suggests.

You're allowed to disagree

A threshold injury classification is a starting position from the insurer, not a final word. Disputes about it can go through internal review and, if needed, the Personal Injury Commission's medical assessment process. See our full guide on threshold injury disputes for the detail on building that case.

Don't let it sit unanswered

The natural reaction to a letter like this is to feel like the decision is final and there's nothing more to do. It isn't, and there is. Time limits on disputing medical classifications are real, so the worst outcome isn't a rejected dispute — it's letting the deadline pass without ever raising one. A free claim check can help you understand your options before that window closes.