In NSW, CTP (Compulsory Third Party) insurance plays a key role in the handling of injury claims and compensation amounts. If you have been injured in a car accident, you may be wondering if your injuries are covered by CTP insurance. The specifics of what injuries are covered depend on a few factors, including the injury threshold, the diagnosis and severity of your injuries, and how quickly you are expected to recover and return to normal life. This guide will explore the injuries covered under CTP insurance, what the injury threshold is, and what you can claim compensation for under the CTP insurance scheme.
Key Takeaways
- CTP insurance in NSW covers compensation for people injured in a car accident, including medical costs and lost income.
- In 2025, the average CTP compensation payout in NSW was approximately $118,000 per new claim, according to SIRA data, though amounts vary significantly by injury severity.
- Injuries covered by CTP insurance are classified as either threshold injuries or non-threshold injuries.
- The injury threshold is determined by how likely a person is to recover from their injuries and return to normal life in a short period of time.
- Threshold injuries, including soft tissue injuries and threshold psychological injuries, are covered by CTP insurance for up to 52 weeks.
- Non-threshold injuries are covered by CTP insurance beyond 52 weeks and claimants can pursue common law claims for future lost income, and, if permanently impaired over 10%, pain and suffering.
What is CTP insurance?
In NSW, CTP insurance is mandatory coverage included in every vehicle registration. This covers compensation for people injured in a car accident caused by your vehicle, including medical expenses, rehabilitation costs, and lost income.
CTP covers injuries to people, not damage to vehicles or property. Property and vehicle damage is covered separately by comprehensive or third-party property insurance.
What injuries are covered by CTP insurance?
If you’ve been injured in a car accident in NSW, the specifics of your injuries will play a key role in what is covered by CTP insurance. The scheme uses a legally defined threshold, which measures your ability to fully recover with appropriate treatment, manage the symptoms of your injuries independently, or with minimal support, and return to your normal life, work and activities within a short period of time.
Insurers will use the diagnosis of your injuries, provided by your doctor or treating health professional, to determine whether your injuries are a threshold injury or not. The assessment from the insurer will then determine how much compensation you receive and what you’re entitled to claim.
Threshold Injuries
A threshold injury is deemed a less serious injury, which can be recovered from within a short period of time with minimal support. There are two types of threshold injuries, soft tissue injury and threshold psychological or psychiatric injury.
A soft tissue injury impacts the tissue that connects, supports, or surrounds your bones and internal organs. These include:
- Whiplash
- Backpain
- Sprains and muscle strains
A threshold psychological or psychiatric injury includes feelings of anxiety, fear, or sadness that do not meet the diagnostic criteria for a psychiatric illness. There are two exceptions in this case, if there is a diagnosis of adjustment disorder or acute stress disorder, it will still be deemed a threshold injury.
Non-Threshold Injuries
Non-threshold injuries are deemed more serious injuries, which require extended and ongoing care. There are two types of non-threshold injuries, physical and psychological.
A physical non-threshold injury includes:
- Fractures
- Nerve damage
- Complete or partial ruptures of tendons, ligaments, and cartilage
- Radiculopathy
A psychological non-threshold injury includes:
- Post traumatic stress disorder (PTSD)
- Major depressive disorder
- Severe anxiety disorders
- Other conditions recognised in the DSM-5
How does the injury threshold impact your claim?
The injury threshold is used to determine the type and length of support you’ll require as you recover from a car accident.
If all your injuries fall are threshold injuries you’ll be entitled to claim up to 52 weeks of income support and medical expenses. Threshold injury claims aren’t entitled to claim a lump sum payout for pain and suffering or any future income loss.
If your injuries are classed as non-threshold injuries, you’ll be entitled to extended support to cover medical expenses and lost income. You’ll also be entitled to file a common law claim for a lump sum payout to cover lost earnings. If your permanent impairment is greater than 10%, you may also be entitled to a lump sum payout for pain and suffering.
It is important to note that if you were at fault for the accident, you will be limited to the 52-week cut off for support, even if you have sustained non-threshold injuries. (These 52-week rules apply to accidents on or after 1 April, 2023, different limits applied to earlier accidents.)
What if you disagree with the insurer’s threshold injury decision?
If the insurer classifies your injury as threshold and you believe it should be non-threshold, you can request an internal review. If the insurer’s decision doesn’t change, the dispute can be escalated to the Personal Injury Commission (PIC) for an independent medical assessment. Insurers don’t always get the classification right, recent PIC decisions have confirmed that injuries such as bone bruising fall outside the legal definition of a threshold injury, even where they might seem minor.
What are you eligible to claim on CTP insurance?
In NSW, CTP insurance covers a range of financial and personal losses that can occur as a result of your injury. What you’re eligible to claim will depend on your injury threshold and if there is any level of fault, these include:
- Medical expenses: This includes hospital and emergency treatments, specialist consultations, diagnostic imaging, surgical procedures, etc.
- Care and support expenses: This includes paid in-home personal care if you need help around the house while you recover.
- Lost income: This covers weekly benefit payments of up to 95% of your pre-accident earnings for the first 13 weeks, reducing to 80% from weeks 14-52 if you have no work capacity, or 85% of your lost earnings if you’re working reduced hours. Beyond week 52, these benefits are only available to not-at-fault claimants with non-threshold injuries.
- Lump sum for future lost income: By filing a common law claim, not-at-fault claimants with a non-threshold injury can receive a lump sum for future lost income as a result of a significantly reduced capacity to work.
- Lump sum for pain and suffering: If the not-at-fault claimant with a non-threshold injury has experienced permanent impairment of 10% or more, they are entitled to file a common law claim to receive a lump sum for pain and suffering.
Common law claims are complex and can significantly affect the compensation you receive. As such, it is important to seek advice from an experienced lawyer at the earliest stage possible. Contact our expert team at Wyatts and receive a free assessment of your claim entitlements.
When to Seek Legal Advice for a CTP Claims and Injuries
Getting legal advice early can significantly improve the outcome of your CTP claim after an accident. It’s best to seek legal advice if:
- Your injuries are ongoing or have resulted in time off work
- Your injury has been classified as non-threshold, or you believe it should be
- The insurer has disputed your claim, reduced your benefits, or made a settlement offer you are unsure about
- You are approaching a claim deadline
- You want to understand what your claim is realistically worth before agreeing to anything
At Wyatts Compensation Lawyers, we work on a no win, no fee basis. There is no financial risk to getting advice. Our team handles car accident claims, truck accident claims, motorcycle accident claims, bicycle accident claims, pedestrian accident claims, public transport accident claims, and more.
If you’ve been in a car accident, find out what you should do after an accident. If you’re filing a CTP claim, find out how much your CTP claim could be worth, or whether you need a lawyer for your CTP claim.
FAQs about Injuries Covered by CTP Insurance
Can you have both threshold and non-threshold injuries?
Yes, if you have both, your entire claim is treated as non-threshold. Following the diagnosis from your doctor, the insurer will separately classify each injury related to the crash, and will then determine which injuries are classed as threshold or non-threshold.
How is the injury threshold determined?
The injury threshold is set out in the Motor Accident Injuries Act 2017 and depends on your diagnosis, not your symptoms. This threshold outlines an individual’s ability to recover fully from their injuries, to manage their symptoms independently, or with minimal support, and to return to their normal life, work and activities within a short period of time.
If your injuries meet these criteria, then they’ll be classed as threshold injuries. If they don’t, then they’ll be classed as non-threshold.
Does CTP insurance cover both threshold and non-threshold injuries?
Yes, if you have sustained both threshold and non-threshold injuries, you only need to file one claim, and it’ll be addressed as non-threshold. Any expenses and support related to your threshold injuries will still be covered under your claim, just as the expenses and support related to your non-threshold injuries are.
