Providing medical services

As a medical professional you play a critical role in treating, advising and educating patients during their recovery.

Medical professionals need to:

  • understand all the benefits available to people claiming under the CTP scheme
  • apply the following reasonable and necessary criteria when proposing treatment services:
    1. directly related to the injuries sustained in the motor vehicle accident
    2. aimed at helping the injured person get back to their usual activities
    3. appropriate for the type of injury
    4. provided by an appropriately qualified health professional
    5. cost effective
  • seek prior approval before commencing treatment to ensure all invoices will be paid. Insurers must decide on requests for services and advise the injured person and medical professional within 10 working days. If a service is declined, the insurer must also provide the reasons in writing within 10 working days
  • use the right process for your request as advised by the insurer
  • ensure the patient understands and agrees to the requests sent to the insurer to achieve their recovery
  • contact the insurer directly with any queries or urgent requests
  • Apply the principles of the clinical framework for the delivery of health services.

Medical certification

In order for the patient to submit a claim, you are required to complete the medical certificate included in the accident notification form or personal injury claim form. Specific details of injuries sustained in the motor vehicle accident and their fitness for work must be included.

Your patient might also like to know more about what happens after they have made a claim.

Fitness for work

The Royal Australian College of Physicians confirms the health benefits of good work and that, in most cases, getting back to good work is an important part of recovery.

When reviewing work fitness you must specify:

  • a clear diagnosis and treatment plan
  • the date the patient can return to work
  • any considerations or modifications they need at work, along with the start and end dates for modifications
  • the modifications that may be required (for example reduced hours or modified duties)
  • the date you will review the patient’s capacity for work (if they're currently unfit for any work)

Providing expert opinion

Medical specialists may also be required to give an expert opinion to help in the assessment of a claim, dispute or settlement.

For more information see:

You can also contact us if you have any questions.

Further information

See the injury advice centre and injury management section for more information about treatment and recovery from injury.