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Workers compensation

In brief

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 guidelines for claiming workers compensation provides additional information on how the claims process works, and what type of payments and expenses may be available.

You might need to know about the Certificate of Capacity and the the Allied Health Recovery Request.

Forms you might need

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 'reasonably necessary' criteria, your patient is personally responsible for payment of accounts.

So before treating your patient please confirm they have submitted a workers compensation claim, and that you have approval from the insurer to start treatment.

There are no gazetted fees for workplace rehabilitation providers in the NSW workers compensation system.

Workplace rehabilitation providers must present itemised invoices before payment can be made.

What your invoices will need to include

  • worker's first and last name, and claim number
  • payee details
  • ABN
  • 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 either the claims technical manual for:
  • 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 must be submitted within 30 calendar days of the service being provided.

Send your invoices to the injured worker’s insurer.

Do I need a SIRA provider number?

Yes. Only organisations wirh 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.

Provider/assessor search

You can find a workers compensation provider/assessor here.