The information for rehabilitation providers will differ depending on which system you work in. Please select which compensation system your client is in.
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Your role can include:
- assessing or reviewing the injured person’s rehabilitation needs
- recommending or planning for appropriate services for the injured person
- assisting the injured person to identify and achieve their goals
- empowering the injured person to manage their injury and recovery
- linking the injured person to the services they need
- facilitating communication between all parties involved in the injured person’s rehabilitation
- supporting the injured person to stay at work or return to work while they recover
- helping the injured person to maintain or recommence usual home and community activities
- monitoring the appropriateness and progress of services being provided.
Rehabilitation provider services should be provided by someone other than a primary treating allied health practitioner. However, in some cases it may be appropriate for the allied health practitioner to perform certain rehabilitation provider tasks. For example, in rural and remote regions the rehabilitation provider may also be the treating occupational therapist.
Rehabilitation provider services should not be provided by an employee of the CTP Green Slip insurer, solicitor, attendant care provider, family member or guardian.
The rehabilitation provider role does not include:
- advocating for the injured person in relation to the management of their claim, litigation or other compensation processes
- providing or recommending services that are not related to the injuries sustained in the motor vehicle accident.
The expectation for rehabilitation provider services for each person should be discussed with the CTP Green Slip insurer and the injured person at the time of referral. All allied health practitioners involved in the recovery plan should be notified that a rehabilitation provider is involved.
Referral for rehabilitation provider services will usually (but not always) be initiated by the CTP Green Slip insurer making contact with the provider.
The insurer may make a referral for rehabilitation provider services for:
- an assessment only, specifying the issues to be addressed (for example review of capacity, review of treatment, vocational, workplace or education assessment or care needs assessment) and a summary of recommendations
- an assessment and rehabilitation plan when it is apparent services will be required.
Once a referral has been received, the rehabilitation provider may want to contact the insurer with any questions about the referral. The insurer may have additional information available that is relevant to the referral.
Rehabilitation providers must always get approval from the insurer before providing services, including initial assessment, to ensure accounts will be paid.
A step by step guide on how to provide rehabilitation services is available in Providing rehabilitation services in the NSW CTP schemes - FAQs.
Forms you might need
All these forms are in Providing rehabilitation services in the NSW CTP schemes - FAQs:
Publications you might need
- Providing rehabilitation services in the NSW CTP schemes - FAQs (advice on how to provide your services)
- Information on the Allied Health Recovery Request
- Clinical framework for the delivery of health services
- The Health Benefits of Good Work
- Minor injury: information for allied health professionals working in the NSW CTP scheme
- the Treatment Advice Centre (advice for professionals to help with treatment)
- the Injury Advice Centre (advice for injured people to help with recovery)
Fees and invoicing
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 days of the request being received
SIRA currently does not have gazetted fees for rehabilitation providers working with a motor accident claimant
You can negotiate with the CTP insurer:
- agreed fees and costs for providing approved treatment
- payment for any request for additional reports or opinions on a claimant’s treatment or progress
- payment for completion of the rehabilitation services request, attendant care request, equipment request or agreed goals of rehabilitation if required to be completed
To facilitate prompt payment by a CTP Green Slip insurer, we suggest you:
- include the appropriate service code with your invoice
- issue the account in the form of a tax invoice and include the:
- injured person’s name
- date of accident
- insurer’s reference/claim number
- 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.
Without prejudice payments
The CTP Green Slip insurer may agree to pay for treatment on a ‘without prejudice’ basis.
Without prejudice means that although the insurer has agreed to pay for treatment, it does not mean they are accepting liability for the accident or will pay for ongoing treatment once they have determined liability.
Agreement to pay without prejudice should be obtained in writing from the insurer before services are provided.
Please include the appropriate service code/s with your invoice. These are available in Providing rehabilitation services in the NSW CTP schemes - FAQs.
Do I need a service provider number?
No. Rehabilitation providers don’t need a SIRA provider number to deliver treatment services in the motor accidents scheme.
Workplace rehabilitation providers help people recover at work
SIRA is not currently accepting applications to approve workplace rehabilitation providers until further notice as we have redirected our resources due to the COVID-19 pandemic.
Workplace rehabilitation services are usually delivered at the workplace, in consultation with all parties and may involve:
- assessing a worker's capacity to perform duties safely
- identifying duties that will support improvements in a worker’s capacity
- identifying options to help reduce work demands (including providing advice on equipment, job or workplace modifications)
- identifying and addressing risks that may impact a worker's recovery at/return to work outcome
- implementing and monitoring a plan to achieve an agreed recovery at work goal
While it is usually the employer or insurer who makes the decision on which workplace rehabilitation provider will be used in each situation, a worker should be consulted on the decision and given the opportunity to refuse or request a change in provider.
The insurer is responsible for engaging the provider and paying for their services. Service costs are recorded as a claims cost.
What to expect from your workplace rehabilitation provider fact sheet provides workers and employers with information about workplace rehabilitation and the role of the provider.
The workers compensation guidelines provides additional information on how the claims process works, and what type of payments and expenses may be available.
You can find a workers compensation provider/assessor here.
Fees and invoicing
There are no gazetted fees for workplace rehabilitation providers in the NSW workers compensation system.
Providers are required to obtain insurer approval before commencing service provision and must present itemised invoices before payment can be made.
- worker's first and last name, and claim number
- payee details
- 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 the technical manual for further information:
- self and specialised insurers, or
- nominal insurer
- 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.
Invoices should be submitted within 30 calendar days of the service being provided.
Send your invoices to the worker’s insurer.
Do I need a SIRA provider number?
Yes. Only organisations with a SIRA provider number and listed on the website are able to deliver workplace rehabilitation services in the workers compensation system
How do I get a SIRA provider number?
Submit an application to the jurisdiction in which approval is being sought, demonstrating how you will meet the Conditions of Approval. If the application is approved, the provider is granted a three-year Instrument of Approval (Certificate of Approval in NSW).
The Conditions of Approval and the application process, including the application form, are outlined in the Guide: Nationally consistent approval framework for workplace rehabilitation providers published by the Heads of Workers Compensation Authorities (HWCA).
The NSW supplement to the guide outlines specific requirements for providers who wish to provide workplace rehabilitation services in NSW.
Meeting the Conditions of Approval
The main focus of the NSW workers compensation system is to support workers to recover at/return to work following a work related injury. So the primary measure for providers is the return to work rate following the provision of workplace rehabilitation services.
The minimum return to work rates that must be maintained by providers in order to maintain approval in NSW are:
- same employer: 80%
- different employer: 50%
We review the minimum return to work rates based on industry performance and regulatory priorities in consultation with the industry.
Work status codes are used to record provider outcomes.
An additional tool called workplace rehabilitation provider performance data spread sheet can be used to assist with the calculation of the return to work rate measures. This tool can also help providers prepare for onsite evaluations and undertake self-evaluations.
Following initial approval, you may be required to undergo an onsite evaluation 12 months after the application approval (initiated by us).
Then, during the three years of approval, you are required to undertake annual self-evaluations. You may also undergo a SIRA-initiated periodic evaluation and/or an exception evaluation by an independent evaluator.
The evaluation process and tools are detailed in the workplace rehabilitation provider evaluation manual. Use the HWCA tool to evaluate yourself against the national framework.
Renewing a Certificate of Approval
You need to submit a renewal application to us prior to the expiration of the prior approval period.
Forms you might need
- Application for approval as a workplace rehabiliation provide form
- Renewal application for approval as a workplace rehabilitation provider
Publications you might need
- Workplace rehabilitation provider evaluation manual
- HWCA self evaluation tool
- Guide: Nationally consistent approval framework for workplace rehabilitation providers
- NSW supplement to the guide
- What to expect from your workplace rehabilitation provider fact sheet
- Information on the Allied Health Recovery Request
- Workers compensation guidelines
- Workers compensation guide for allied health practitioners
- A quick guide to workers compensation - information for workers