Fees paid for motor crash health services

This includes:

• chiropractors
• exercise physiologists
• massage therapists
• osteopaths
• physiotherapists
• psychologists, social workers and counsellors

Fees

SIRA does not designate fees for allied health providers working with patients with motor crash claims.

You can engage with the CTP insurer regarding:

• approved treatments
• additional reports or opinions
• completing any necessary requests related to rehabilitation goals, such as for equipment or attendant care.

To ensure prompt payment by a CTP insurer, you should:

• include the appropriate service code, as detailed in the Providing allied health services in the NSW Compulsory Third Party (CTP) Scheme FAQs, with your invoice
• issue the account in the form of a tax invoice and include the person’s name, date of crash, insurer’s reference/claim number and your ABN, address and GST (if applicable)
• send accounts directly to the CTP insurer
• direct all enquiries about payment to the person’s claims officer.

Without prejudice payments

Insurers may offer to pay for treatment on a ‘without prejudice’ basis, which means they cover costs without formally accepting liability. Providers are encouraged to always secure this agreement in writing before providing services.

Declined claims

If the insurer declines liability or a treatment request because it does not meet the 'reasonable and necessary' criteria, your patient is personally responsible for payment of accounts. Ensure your patient has submitted a CTP claim and you have approval from the insurer before providing treatment.

The insurer will approve one general practitioner consultation and 2 treatment consultations by an allied health provider once they have received notification of the injury.

If your patient then makes a claim and the insurer denies liability or declines a treatment request because it does not meet the 'reasonable and necessary' criteria, they are personally responsible for payment of accounts.

Ensure your patient has submitted a CTP claim and you have approval from the insurer before providing treatment.

Fees

SIRA does not designate fees for doctors working with people with motor crash claims.

The limit on treatment and care expenses is the applicable Australian Medical Association (AMA) rates at the time the treatment/service is provided, as outlined in section 4.100 of the Motor Accident Guidelines.

The insurer must pay your account within 20 calendar days of receiving an invoice or expense.

To ensure prompt payment by a CTP insurer, you should:

• include the appropriate AMA item number/s with your invoice
• issue the account in the form of a tax invoice and include the patient’s name, date of crash, insurer’s reference/claim number and your ABN, address and GST (if applicable)
• send accounts directly to the CTP insurer
• direct all enquiries about payment to the patient’s claims officer

Fees

The maximum fees for medicolegal services are set out in monetary units in Schedule 2 of the Motor Accidents Injuries Regulation 2017. These fees are adjusted each year in line with inflation, as set out in Schedule 3 of the Motor Accident Injuries Regulation 2017.

Non-medical health practitioners are bound by the maximum witness appearance fees but not by the maximum fees for medical reports.