Complete this form to apply for appointment as a health practitioner authorised to give evidence in the NSW Motor Accident scheme - under s7.52 of the Motor Accident Injuries Act 2017 and part 8 of the Motor Accidents Guidelines.
Instructions
Complete all relevant sections and attach evidence where indicated.
Required fields are marked with an asterisk (*).
Before starting, make sure you have everything you need to complete your application. You cannot stop or save an application.
Save all attachments (ready to upload) with your name and description as the file name - no longer than 50 characters or 2MB per attachment (Word, PDF or JPG).
What you will need:
- AHPRA registration number
- certificate(s) of successful completion of permanent impairment training (if applicable)
- current resume
Privacy
Information you provide will be managed in accordance with the SIRA Privacy Statement.
Your name in Section 1 and all information provided in Section 2 will be made publicly available on the SIRA website.
More information
If you have any questions or require assistance, call 13 10 50 or send an email.
1. Your details
2. Health practitioner details
This information will be published with your name on the SIRA website.
2.1 Practice details
Practice 1
Practice 2
Practice 3
Additional practice locations
If you have more than three practice locations, please include the details of additional locations on a separate document and attach below.
2.2 Assessment of permanent impairment - body systems
SIRA provide mutual recognition for training successfully completed in the evaluation of permanent impairment for two modules across Motor Accidents (CTP) and workers compensation (WC) schemes in NSW:
- Mental and Behavioural (CTP) and Psychiatric and psychological disorders (WC)
- Visual system (CTP and WC)
If you have successfully completed the Psychiatric and psychological disorders or Visual system training for the NSW WC scheme you may apply to be listed for these modules as a health practitioner authorised to give evidence.
3. Eligibility requirements
3.1 AHPRA registration
Practitioners are NOT eligible for appointment if they have any conditions, undertakings, reprimands, limitations or restrictions on their registration as a result of a disciplinary process, or are subject to supervisory requirements, or have any other provisions that may adversely impact performance in the role.
3.2 Five years relevant clinical experience
Practitioners are required to have at least 5 years relevant clinical experience. Clinical experience is defined as:
- Providing direct clinical care and/or providing oversight of direct clinical care of patients, and/or directly involved in the clinical education of students (either pre-registration or post-registration).
- The clinical experience, whether remunerated or not, must be obtained in your area of expertise (specialty) after you have completed all relevant training, are fully qualified, and not subject to supervisory requirements.
3.3 Recency of practice
The practitioner “is in current clinical practice or a teaching position in the relevant specialty, or has recently been in clinical practice, or undertakes professional activities such that they are aware of current clinical practice.”
Further information is provided in Guidance Note – Recency of practice for health practitioners.
3.4 Knowledge of the treatment and management of injuries in personal injury schemes and return to activity
The practitioner has knowledge of the treatment and management of injuries in personal injury schemes and return to activity.
3.5 High-level communication skills, including interpersonal and report writing skills
The practitioner must have high-level communication skills, including interpersonal and report writing skills, to comply with the requirements for consultations, examinations and reports outlined in the NSW Medical Council Guideline - Medico-legal consultations and examinations.
3.6 Other criteria
When reviewing an application, SIRA may consider other relevant information. This may include if the applicant has:
- been subject to a complaint made to insurance, compensation or health authorities, government agencies or statutory bodies regarding the applicant’s conduct in the last 10 years
- had any demonstrated breach of legislation, guidelines or fee schedules in any statutory insurance compensation system in any Australian jurisdiction in the last 10 years
- any pending criminal charges or any criminal convictions
- demonstrated behaviour that may affect the applicant’s ability to undertake the role with impartiality and fairness or may affect the integrity of the CTP scheme.
4. Acknowledge and declaration
I acknowledge and understand that:
- failure to provide information requested by SIRA within the required timeframes, to assist SIRA in determining this application, may result in the application not being assessed
- appointment as a health practitioner authorised to give evidence by SIRA does not guarantee any work in the role
- by submitting an application, I consent to SIRA collecting information from other persons or bodies, including third parties, to determine whether I meet the eligibility requirements
- the information provided will be used to assist SIRA establish, monitor and review registration and membership details upon application and throughout the appointment period, and
- I must notify SIRA within seven days if I become aware that information provided in this application, including the declaration below, was incorrect or incomplete.
I declare that:
- The information provided in this application is true and correct.
- I am the person named in the application and attached documents.
- I have the relevant insurances required as part of my AHPRA registration as a health practitioner with appropriate coverage for my area(s) of practice.
- I have read and understood:
- I have read SIRA’s Privacy Statement, and if my application is successful, I agree:
- to be bound by the terms of appointment in Part 8 of the Motor Accident Guidelines, including undertaking 2 hours of continuous professional development related to medico-legal practice during my three-year period of authorisation. (More information is available in the Guidance note - Continuing professional development).
- to have my details as outlined in Sections 1 and 2, and any other details relevant to the role I have applied for, published on the SIRA website.
