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Motor accidents

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 Rehabilitation providers providing relevant services in the CTP scheme:

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

In brief

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.

You might need to know about the certificate of fitness/certificate of capacity and the the allied health recovery request.

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

Forms you might need

All these forms are in Providing rehabilitation services in the NSW CTP schemes - FAQs:

Publications you might need

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 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

What can I do to get paid quickest?

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.

Service Codes

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.

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