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Doctors and other medical professionals

Doctors may treat people who have a workers compensation or motor accident claim. Details of how you work in either of the two systems is available here.

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Motor accidents

Workers Compensation

Motor accidents

This information is for doctors with patients who have been injured in a motor accident in NSW. As a doctor, you may also be interested in learning about treating workers compensation patients, or in becoming a health practitioner authorised to give evidence in the NSW CTP Scheme.

Guidelines for the provision of relevant services have been published

SIRA has published the Guidelines for the Provision of Relevant Services (Health and Related Services), which apply to relevant service providers providing services in the NSW workers compensation and CTP (for accidents on or after 1 December 2017) schemes.

The following sections of the guidelines apply to medical practitioners providing relevant services in the CTP scheme:

This webpage has been updated to include content from the Guidelines and the associated legislation.

In brief

Doctors can help facilitate a patient’s treatment and recovery from injury/illness. Evidence shows that staying at work or returning to work promotes recovery and leads to better health outcomes. For patients who aren’t working, returning to their usual activities will lead to better health outcomes.

No matter what type of doctor you are, your role supporting patient recovery is an important one.

You can 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 insurers, allied health practitioners, employers and other parties involved in the management of the injury
  • promoting the health benefits of good work, if appropriate
  • 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 CTP motor accident claim.

SIRA’s Treatment advice centre provides information and guidelines for doctors and other health professionals on common motor accident injuries. SIRA’s Injury advice centre can help your patient understand their injury and recovery.

This video explains how doctors and employers can work together to help your patient recover at work. Although aimed at doctors with workers compensation patients, it also applies to doctors treating people injured in motor accidents.

Your patient can also benefit from other supports to recover at work or return to work, including vocational support.

Refer to the Guidelines for the Provision of Relevant Services (Health and Related Services) for the code of conduct that all service providers, including doctors and other medical professionals, must comply with.

Doctors working in public hospitals

If you work in a public hospital and can exercise rights of private practice, it is important to understand billing arrangements and the role of the CTP insurer.  Please read this factsheet, developed by SIRA, NSW Health, the Australian Medical Association (NSW) and the Australian Salaried Medical Officers' Federation of NSW.

Medical certificates

The certificate of capacity/certificate of fitness is usually completed by the GP but can be completed by any treating doctor.  It’s the same form as that used in the NSW workers compensation system, and there is information to help doctors complete it correctly. Your patient will need a completed medical certificate, ideally the certificate of fitness/certificate of capacity, to make a claim for motor accident compensation.

If you are completing a certificate of capacity/certificate of fitness it is important to consider your patient’s capacity, including:

  • 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/place of study.

It may also be useful to understand how 'minor injury' is defined in the scheme.

Fees and invoicing

Get treatment approval first

The insurer should approve access to treatment, such as one general practitioner consultation and two treatment consultations (for example, physiotherapy), before a claim is made but after notification of injury has been given.

If, once your patient has made a claim, the insurer denies liability, or declines a treatment request because it does not meet 'reasonable and necessary' criteria, your patient may be 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 days of the request being received.

There are no fees orders for doctors working in the CTP motor accidents scheme.

The limit on treatment and care expenses is the applicable Australian Medical Association (AMA) rates at the time the treatment/service is provided, as per the Motor Accident Guidelines.

Insurers are only obliged to pay for treatment and care which is deemed ‘reasonable and necessary’ as a result of the injury.

What can I do to get paid promptly?

The insurer must pay your account as soon as possible but within 20 calendar days of receipt of an invoice or expense. To facilitate prompt payment, please:

  • include the appropriate AMA item number/s with your invoice
  • issue the account in the form of a tax invoice and include the:
    • patient’s name
    • date of accident
    • insurer’s reference/claim number
    • provider’s ABN, address and GST (if applicable)
  • send accounts directly to the CTP insurer (rather than your patient or their solicitor)
  • direct all enquiries about payment to the claims officer you have been dealing with under the Motor Accidents Injuries Act 2017.

Forms and resources

Treatment advice and guidelines

Support and information for your patient

SIRA publications

Workers Compensation

Guidelines for the provision of relevant services have been published

SIRA has published the Guidelines for the Provision of Relevant Services (Health and Related Services), which apply to relevant service providers providing services in the NSW workers compensation and CTP (for accidents on or after 1 December 2017) schemes.

The following sections of the guidelines apply to medical practitioners providing relevant services in the workers compensation scheme:

This webpage has been updated to include content from the Guidelines and the associated legislation.

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 play an important role in the facilitation of treatment and recovery for a worker following a workplace injury.

Doctors support a workers’ 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 their employer, the insurer and other parties involved in the management of their injury
  • applying the principles of the clinical framework for the delivery of health services.

It is important to work in collaboration with all parties involved in the management of the workers’ injury.

In the NSW workers compensation system the general practitioner (GP), specialist or surgeon is responsible for the ongoing management of a workers’ injury and is referred to as the nominated treating doctor (NTD). Apart from assessing, diagnosing, treating and certifying patients, the role of the NTD includes supporting the patient with their recovery at/return to work. This also involves contributing to recovery at/return to work planning in collaboration with the worker and other members of the support team.

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.

Refer to the Guidelines for the Provision of Relevant Services (Health and Related Services) for the code of conduct that all service providers, including doctors and other medical professionals, must comply with.

Medical certificates

SIRA has a common 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.

All patients should provide the insurer with a completed certificate of capacity/certificate of fitness to claim for workers compensation.

When completing the certificate of capacity/certificate of fitness it is important to consider:

  • the nature of the injury/illness
  • the diagnosis
  • the treatment required to assist with recovery from the injury/illness
  • the patient's capacity for work taking into consideration their capacity for other activities
  • proposed dates
  • any considerations or modifications in the home or workplace that may assist the worker with their recovery.

Fees and invoicing

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Get treatment approval first

If an insurer disputes liability, or declines a treatment request because it does not meet reasonably necessary criteria, the worker may be personally responsible for the payment of accounts. Before commencing treatment, a doctor should contact the insurer to confirm they have an accepted workers compensation claim and the proposed treatment or service is approved. Some treatment and services may not require pre-approval from the insurer. The Workers compensation guidelines provides clarification on accessing treatment without prior approval.

The fees orders provide a maximum fee for services provided to a worker. You cannot exceed the maximum fees stated in the Fees Order.

For a summary of the most commonly used GP codes please refer to the SIRA rates for general practitioners (effective 1 February 2024).

All fees you can charge are listed in the relevant fee order below:

Current health-related fees

These are the current health related fees and rates orders.

Historical health-related fees

These are the historical health related fees and rates orders.

Fees and rates orders 2024

Fees and rates orders 2023

Fees and rates orders 2022

Fees and rates orders 2021

Fees and rates orders 2020

Fees and rates orders 2019

Fees and rates orders 2018

Fees and rates orders 2017

What invoices need to include

SIRA requires medical practitioners and other service providers to provide itemised invoices before payment can be made by the insurer.

Invoices for relevant services rendered must include:

  • the injured worker’s first and last name, and claim number
  • payee name, address, telephone number and email address
  • payee Australian Business Number (ABN)
  • name of the relevant service provider who delivered the relevant service
  • in the case of medical practitioner services, the provider’s:
    • Australian Health Practitioner Regulation Agency (AHPRA) number, and
    • Medicare provider number (unless not registered with Medicare).
  • in the case of private hospital services, the service’s:
    • Medicare Benefits Schedule item (if applicable)
    • theatre banding (if applicable)
      • if the invoice is for a higher-banded procedure which requires a complexity certificate, the certificate of complexity must accompany the invoice.
    • theatre duration (if applicable).
  • in the case of invoices for surgery:
    • a detailed operation report including a description of the initial injury and an outline of the mechanism of injury, time surgery commenced and finished, intra-operative findings and the procedures performed, including structures that were repaired (stating the anatomic location) and technique of repair.
  • relevant SIRA payment classification code or Australian Medical Association (AMA) Fees List item number (where applicable)
  • service cost for each SIRA payment classification code or AMA Fees List item number and service duration (if applicable)
  • date of service
  • date of invoice (must be on the day of or after last date of service listed on the invoice).

Invoices must be submitted within 30 calendar days of the service being provided.

Invoicing for medical reports

When a medical practitioner receives a request for a medical report it’s important to clarify with the referring party the purpose of the request.

If the report is to provide an opinion in relation to a dispute or potential dispute in respect of a claim made by a worker, refer to the Workplace Injury Management and Workers Compensation (Medical Examinations and Reports Fees) Order (refer to the current health-related fees tab above). Reports by general practitioners and medical specialists have different maximum gazetted rates.

If the report is to provide information in relation to the routine medical management of a worker’s injury and/or matters relating to recovery at/return to work, refer to the Workers Compensation (Medical Practitioner Fees) Order (refer to the current health-related fees tab above. General practitioners, medical specialists and consulting surgeons have different hourly rates for this service as stated in the Fees Order. The medical practitioner should consult with the referring party to establish an agreed timeframe and the appropriate fee for completion of the requested report.

Forms you might need

Publications you might need

Further information

For more information on the role doctors play in the NSW workers compensation system, please refer to this AMA presentation.

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