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 an authorised health practitioner in the NSW CTP scheme, or becoming a medical assessor in SIRA’s Dispute Resolution Service.
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.
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.
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 working 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
- Whiplash guidelines
- Treating traumatic brain injury
- Emotional recovery in children
- Clinical framework for the delivery of health services