SIRA’s new Guidelines detail expectations of health-related service providers in personal injury schemes
11 December 2023
The Guidelines for the Provision of Relevant Services (Health and Related Services) (the ‘Guidelines’) set out SIRA’s service and billing expectations for health-related service providers in the workers compensation and CTP schemes.
The Guidelines will help create positive health outcomes for injured people by ensuring services are appropriate, timely and cost-effective.
The Guidelines are part of health and related provider regulation under the State Insurance and Care Governance Act 2015 (SICG Act), and the State Insurance and Care Governance Regulation 2021 allowing SIRA to issue a direction to health-related service providers for not complying with provision of services, billing and code of conduct expectations.
Most health-related service providers are already doing the right thing in the schemes, however some outlier providers have a demonstrated pattern of poor performance. The Guidelines will make SIRA’s expectations clear.
The Guidelines include:
- a code of conduct
- requirements for telehealth services
- clear requirements for billing and invoicing
- practice requirements for independent medical examiners in the workers compensation scheme.
SIRA will regulate behaviours that don’t comply with the Guidelines, as well as the workers compensation and motor accidents legislation, regulations, and guidelines made under that legislation. For example:
- reports that don’t comply with requirements in guidelines
- billing for amounts that are more than the maximum fee fixed by SIRA
- billing for items they are not eligible to be paid for (e.g. billing a medical specialist item when they are not a medical specialist).
SIRA’s regulatory response to any non-compliance will give providers the opportunity to make submissions about the matter, and why further compliance action by SIRA is not warranted.
Part 8 of the guidelines provides a brief summary of which parts of the Guidelines apply to which providers.
Further information
- Read the Guidelines for the Provision of Relevant Services (Health and Related Services)
- Read SIRA's Supervision of Relevant Service Providers: Information for Providers
- Contact SIRA with any feedback or questions.