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Doctors and other medical professionals

Evidence shows staying at work or returning to work promotes recovery and leads to better health outcomes. In most cases, this means getting back to good work is an important part of recovery.

In brief

Doctors can help facilitate a patient’s treatment and recovery from injury/illness.

No matter which type of doctor you are or which scheme your patient is in, your role supporting patient recovery is an important one.

You will support your patient's recovery by:

  • educating them on their injury and recovery options
  • where appropriate, recommending treatment to help in their recovery
  • acting as the primary contact for treatment and recovery information for employers, insurers and other parties involved in the management of the injury
  • applying the principles of the clinical framework for the delivery of health services.

It is important that you work in collaboration with all parties involved in the management of the injury/illness. This will help facilitate the patient's recovery and their claim in the NSW workers compensation system or motor accident scheme.

See the Injury advice centre and Treatment advice centre section for more information about treatment and recovery from injury.

In the NSW workers compensation system - whether you are the general practitioner (GP), specialist or surgeon - if you have agreed to be responsible for the ongoing management of a person’s injury/illness, you may be referred to as the nominated treating doctor (NTD).

Learn more about the role doctors play in the NSW workers compensation system with this AMA presentation.

Watch this video on how doctors and employers can work together to help a worker recover at work.

Surgeons

This information relates to workers compensation only.

A surgeon is a medical practitioner who is currently:

This includes a surgeon who is a staff member providing services at a public hospital.

Orthopaedic surgeons

This information relates to workers compensation only.

An orthopaedic surgeon is a medical practitioner who is recognised by the Medical Board of Australia or Medicare Australia as a specialist in orthopaedic surgery and who is registered with AHPRA as a specialist in the field of orthopedic surgery.

This includes an orthopaedic surgeon who is a staff member providing services at a public hospital.

In the workers compensation system, arrangements between the Australian Society of Orthopaedic Surgeons and SIRA ensure workers have priority access to orthopaedic surgeons.

Medical specialists

This information relates to workers compensation only.

Medical specialists may be required to give an expert opinion to help in the assessment of a claim, dispute or settlement. For more information see:

You can also contact us if you have any questions.

Medical certificates

SIRA has one medical certificate for both the workers compensation system and motor accident scheme. This is called the certificate of capacity/certificate of fitness. There is information to help you complete this document correctly.

All patients need a completed certificate of fitness/certificate of capacity to claim for compensation in either scheme.

When completing the Certificate of capacity/Certificate of fitness it is important to consider the abilities of the patient. Think about:

  • the nature of the injury
  • the diagnosis
  • the treatment required to help with injury recovery
  • the patient's capacity for work and other activities with proposed dates (where appropriate)
  • any considerations or modifications the patient may benefit from either at home or their workplace.

Fees and invoicing

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Get treatment approval first

If the insurer denies liability, or declines a treatment request because it does not meet 'reasonable and necessary' criteria, your patient is personally responsible for payment of accounts. So before treating your patient please confirm they have submitted a CTP claim and you have approval from the insurer to start treatment.

Insurers must provide a written response within 10 working days of the request being received

Fees and invoicing differs depending on which scheme you are working in. Please select one:

Workers compensation

GPs providing treatment to a worker are paid in accordance with the Workers Compensation Medical Practitioner Fees Order.

For a summary of the most commonly used GP codes please refer to the 2017 SIRA rates for general practitioners.

The Surgeon Fees Order sets the current maximum fees for treatment by a surgeon, while the Orthopaedic Surgeons Fees Order sets the current maximum fees for orthopaedic surgeons. Fees Orders are gazetted in NSW Parliament every year.

See also the 2016 Fees Orders for:

What your invoices will need to include

  • worker's first and last name, and claim number
  • payee details
  • ABN
  • name of the medical practitioner or service provider who provided the service
  • SIRA workers compensation approval number or medical practitioner's Health Insurance Commission provider number (where applicable)
  • date of service
  • SIRA workers compensation payment classification code or AMA item number where applicable. Refer to either the claims technical manual for:
  • service cost for each SIRA workers compensation payment classification code or AMA item number and service duration (if applicable)
  • date of invoice (must be on the day of or after last date of service listed on the invoice)

To prevent delays in payment, these details will need to be provided on all invoices.

Motor accident (CTP) scheme

There are currently no fees orders for medical practitioners working in the motor accidents scheme.

The insurer is responsible for paying for patient treatment that has been assessed as 'reasonable and necessary' as a result of the injury.

You need to seek approval before commencing treatment to ensure all invoices will be paid.

What can I do to get paid quickest?

To facilitate prompt payment, we suggest you:

  • include the appropriate service code/s with your invoice (available in the motor accidents guide for allied health practitioners).
  • issue the account in the form of a tax invoice and include:
    • the injured person’s name
    • date of accident
    • the insurer’s reference/claim number
    • the provider’s ABN, address and GST (if applicable)
  • send accounts directly to the CTP Green Slip insurer. It is difficult to ensure timely submission of accounts by other parties (for example, an injured person or their solicitor).
  • direct all enquiries about payment to the claims officer you have been dealing with.