SIRA Logo

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

alert icon

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.

Print PDF

Contact us