Threshold Injury Disputes: Challenging a 'Minor Injury' Decision

What a threshold injury is

From 1 April 2023, the term 'minor injury' was replaced by 'threshold injury'. You will still see 'minor injury' in older letters, and it applies to accidents before that date. A threshold injury is generally a soft tissue injury, for example to muscles, tendons or ligaments, and/or a threshold psychological injury.

Some injuries are generally not soft tissue injuries for these purposes, even though they involve soft tissue. These include nerve damage and a full or partial tear of a tendon, ligament, meniscus or cartilage.

Psychological injuries are assessed separately. Some short-term psychological reactions are treated as threshold psychological injuries, while more serious diagnosed conditions may not be. How the condition is diagnosed and documented by a psychiatrist or psychologist matters a great deal.

Why the classification matters so much

In practical terms, the same whiplash-type injury can lead to a 52-week claim or to a longer claim with a damages component, depending on what the evidence shows. See minor vs non-minor injury.

• Benefit period: for accidents on or after 1 April 2023, people with a threshold injury can receive statutory benefits for up to 52 weeks. For accidents from 1 December 2017 to 31 March 2023, the limit for minor injuries was generally 26 weeks.
• Damages: you can only claim common law damages if your injury is more than a threshold injury.
• Treatment: for threshold injuries, treatment beyond the benefit period may sometimes be allowed, but only in limited circumstances.

Where disputes usually arise

• Neck or back injuries with symptoms radiating into an arm or leg, which may suggest nerve involvement.
• Scans showing a partial tear that the insurer has treated as a sprain or strain.
• Shoulder or knee injuries where a tear of a tendon, ligament or meniscus is suspected but hasn't been investigated.
• Psychological injuries where the person has not yet been assessed by a psychiatrist or psychologist.
• Decisions made early, before scans, specialist opinions or nerve studies were done.

How to challenge a threshold injury decision

Start with an internal review by the insurer, generally within 28 days of receiving the decision. If the decision stands, the dispute can go to the Personal Injury Commission for a medical assessment by an independent medical assessor. A review of a medical assessment certificate must generally be sought within 28 days of the certificate being issued.

The evidence that helps

Most of the evidence in a threshold dispute comes from your treating team. If you don't yet have a doctor who knows the CTP scheme, or you need a psychological assessment, see doctors and allied health. Evidence that commonly helps includes:

• Imaging (MRI, CT or ultrasound) that identifies any tear or structural damage.
• Nerve conduction studies or a specialist's clinical findings where nerve damage is suspected.
• A treating specialist's report that addresses the legal definition directly, not just the symptoms.
• A diagnosis from a psychiatrist or psychologist for any psychological injury.
• Consistent records from your first medical visit onwards.

Don't let the 52-week mark sneak up

If you have a threshold injury decision and your benefits are approaching the 52-week mark, the timing matters. Challenging the decision early gives you the best chance of avoiding a gap in treatment and weekly payments, and keeps a possible damages claim alive.

When to talk to a lawyer

Because this decision controls access to damages, it is one of the most common reasons people speak to a CTP lawyer. See CTP dispute lawyer for how we connect people with one. Talk to a lawyer if:

• Your treating practitioners think your injury is more than a soft tissue injury.
• You have symptoms such as pins and needles, numbness or weakness, or scans showing a tear.
• You have a diagnosed psychological condition that the insurer has treated as threshold.
• Your benefits are about to stop and you believe the classification is wrong.