HAS THE INSURER STOPPED PAYMENTS BECAUSE YOUR INJURIES ARE SAID TO BE THRESHOLD?
- Article
- 12 May 2025
Many clients have come to us because they have received letters from the insurance company advising them that, in the opinion of the insurance company, their injuries are considered to be threshold injuries and therefore they are not entitled to any additional compensation after the first 52 weeks following the accident.If that is you then you do not have to take no for an answer. The important thing to know is that you can challenge such a decision.
This is very important because if your injuries are non-threshold the insurer is obliged to make ongoing payments past the initial 52-week period. In addition, and perhaps most importantly of all, it opens up the opportunity for you to bring a claim for common law damages which is the only means by which people injured in motor vehicle accidents in New South Wales can receive lump sum compensation.
A case in point involved one of our clients who was injured in a motor vehicle accident several years ago. He had seen two different firms of solicitors before eventually coming to us in August last year. In his case the insurance company had made a determination that his injuries were threshold and therefore all his benefits were cut off. He was not happy with the decision but each of the other solicitors he spoke to said there was nothing that they could do. When he came to us I thought that it should be possible to challenge this decision and so we asked the insurance company to undertake an internal review. However, they stuck by their original decision that the client’s injuries were threshold.
Understandably the client was not happy with this and so we brought a challenge in the Personal Injury Commission. We obtained medical evidence from his treating specialist in support of his case and the assessor to whom he was referred agreed with us that his injuries were non-threshold. This was very pleasing indeed because it meant that the client was eligible to claim ongoing benefits and, in addition, for the first time, he could bring a claim for lump sum common law damages.
The next step was to have him assessed to see if his whole person impairment (WPI) was greater than 10%. This is important because it is only if your injuries are assessed as being greater than 10% WPI that you are eligible for compensation for pain and suffering.
As the client was retired, unless he was assessed as being over the threshold, he was not going to recover any additional compensation by way of common law damages.
We asked the insurance company to concede that he was over the threshold but they refused to do so. We therefore filed yet another application to the Personal Injury Commission who arranged for our client to be assessed. On assessment he was found to have 25% WPI comfortably clearing the 10% WPI threshold. This meant that he was eligible for compensation for pain and suffering.
Once we had that certificate, we were very shortly thereafter able to settle our client’s case at a settlement conference for $300,000. Before we came into the case they weren't offering a cent.
To say the least the client was over the moon. He had gone from a situation where he was told he was not eligible for any further compensation and there was nothing that could be done about it to a situation where he was not only entitled to ongoing benefits but also lump sum compensation in the sum of $300,000.
This only goes to show that if you’ve been told your injuries are threshold you don’t have to take no for an answer! Contact us. We’ll have a look at your case and see whether or not we think we can get that decision overturned for you.