This guide provides practical advice to allied health practitioners (and others) on the most common topics relevant to delivering services to someone injured under the NSW CTP scheme. Changes have been made to the CTP scheme from 1 December 2017 and the guide is currently being updated. For enquiries, contact CTP Assist on 1300 656 919 or email [email protected].
This guide was developed to facilitate effective communication between allied health practitioners and CTP Green Slip insurers, so that people injured in motor vehicle accidents obtain appropriate, cost effective treatment leading to the best possible outcomes. This guide will also enable timely approval of services and payment of accounts.
This guide:
This guide was developed in conjunction with:
All allied health practitioners should apply the nationally endorsed Clinical Framework for the Delivery of Health Services when treating people injured in motor vehicle accidents.
The clinical framework has been established to:
The five principles of the clinical framework are:
All allied health practitioners should be aware of The Health Benefits of Good Work (HBGW). This is an initiative from the Australasian Faculty of Occupational and Environmental Medicine (AFOEM) of The Royal Australasian College of Physicians (RACP). It is based on compelling Australasian and international evidence that good work is beneficial to people’s health and wellbeing and that long term work absence, work disability and unemployment generally have a negative impact on health and wellbeing.
Evidence of the incorporation of the Clinical Framework and the research on the health benefits of good work is expected of all allied health practitioners.
Under the Motor Accidents Compensation Act 1999, CTP Green Slip insurers are only obliged to pay for treatment that's considered ‘reasonable and necessary’. You need to take this into account when proposing treatment.
An item considered to be reasonable and necessary in one case may not be considered reasonable and necessary in another.
Shower or bath aids may be appropriate to request for a person with lower limb fractures who lives alone when the alternative is the provision of attendant care. However, a request for the same equipment for someone with a WAD II whiplash injury may not be considered reasonable and necessary.
The criteria for reasonable and necessary treatment are:
Below is brief information about Green Slips and how an injured person will make a claim under the NSW Motor Accidents CTP Scheme.
A Green Slip is an insurance policy everyone must take out to be able to register their vehicle in NSW. It provides compensation for people injured in a motor vehicle accident.
If a person is injured (but not at fault) in a motor vehicle accident, they can make a claim for a range of benefits including past and future medical treatment and rehabilitation costs, care costs and economic losses, as well as payments for pain and suffering (in some circumstances).
If a person is injured (and at fault) the Green Slip may provide limited cover, up to the first $5,000 of treatment costs and lost income incurred in the first six months after an accident.
Not all people injured in motor vehicle accidents are covered under the NSW Motor Accidents CTP Scheme, so it’s important you check your client's compensation status and identify the relevant insurer.
You can do this by checking whether they have submitted a personal injury claim form (PICF).
If the injured person expects their expenses will be more than $5,000, or the recovery will take longer than six months, and they were not at fault in the crash, they complete a PICF and send it to the insurer within six months of the accident (if they can't open this interactive form in their browser they can download this static version).
Depending on the circumstance of the accident, the injured person may be entitled to compensation that includes:
Your role and the way you provide services will depend on whether you are a single allied health practitioner (such as a physiotherapist, exercise physiologist, chiropractor, osteopath, acupuncturist, psychologist, counsellor, dietician, speech pathologist, occupational therapist) or a rehabilitation provider (including case manager, vocational provider).
Your roles include:
Below is a step by step guide to how you provide those services:
Referral for single allied health practitioner services will usually be initiated by the injured person. At times the referral will be initiated by the general practitioner or rehabilitation provider.
If it is evident at the initial assessment that ongoing treatment is required, you will need to complete the allied health recovery request (AHRR) and submit to the CTP Green Slip insurer for consideration. Phone communication with the insurer is only recommended if there are extenuating circumstances, complex issues or urgent needs.
At times the insurer may request additional information to the AHRR (for example a specific report or a rehabilitation services request, if so, you will need to agree on the payment for this).
Approval must be received before commencing treatment to ensure all accounts will be paid.
The insurer will use the information provided in the allied health recovery request to decide whether proposed services are reasonable and necessary.
They may contact you to discuss the plan or request additional information or clarification. This might include filling out other forms (listed in this guide).
They must provide a written response within 10 working days of the request being received. If they are declining or partially declining any treatment they will provide the reason/s.
If you don't receive a response within this timeframe you need to contact them to ensure you have approval.
In cases where treatment proceeds without approval from the insurer, you should discuss options for payment with the injured person beforehand.
All treatment and rehabilitation is aimed at empowering the injured person to self-manage their symptoms and recovery. So it may be appropriate for services to stop before they have fully achieved their goal(s). This will need to be determined on a case-by-case basis.
You will generally not be required to provide a case closure summary to the insurer at the completion of treatment.
You are however expected to update key parties (for example general practitioner, other allied health practitioners, case managers, rehabilitation providers) on the injured person’s progress throughout the time you are providing services.
Referral for rehabilitation provider services will usually (but not always) be initiated by the CTP Green Slip insurer making contact with the provider.
The insurer may make a referral for rehabilitation provider services for:
Once a referral has been received, the rehabilitation provider may want to contact the insurer with any questions about the referral. The insurer may have additional information available that is relevant to the referral.
Rehabilitation providers must always get approval from the insurer before providing services, including initial assessment, to ensure accounts will be paid.
The rehabilitation provider should contact the insurer after conducting the initial assessment to discuss the findings. It may be appropriate to explain the expected goals, timeframes and recommended services.
If treatment is recommended you will submit a rehabilitation services request form to the CTP Green Slip insurer.
This initial contact is important to enable collaboration and alignment of any proposed rehabilitation plan requests.
The insurer will use the information provided in the rehabilitation services request to decide whether proposed services are reasonable and necessary.
They may contact you to discuss the plan or request additional information or clarification. You may also be required to fill out other forms (listed in this guide).
They must provide a written response within 10 working days of the request being received. If they are declining or partially declining any treatment they will provide the reason/s.
If you don't receive a response within this timeframe you need to contact them to ensure you have approval. In cases where treatment proceeds without approval from the insurer, you should discuss options for payment with the injured person beforehand.
All treatment and rehabilitation is aimed at empowering the injured person to self-manage their symptoms and recovery. So it may be appropriate for services to stop before they have fully achieved their goal(s). This will need to be determined on a case-by-case basis.
The insurer may require a case closure report from you when:
You need to check with the insurer if they require a case closure report. The rehabilitation services request can be used for case closure.
If you need to contact the injured person's CTP Green Slip insurer, below are their details.
AAMI CTP Claims Department
Allianz CTP Claims Department
GIO CTP Claims Department
NRMA CTP Claims Department
QBE CTP Claims Department
Suncorp CTP Insurance
Zurich CTP Claims Department
Which form to fill out depends on whether you are a single allied health practitioner or a rehabilitation provider, as well as the individual circumstances of the injured person.
Below is a list of the most common forms you might need.
Use the rehabilitation services request form if you are a rehabilitation provider to report on an assessment of capacity, treatment outcome, vocational, workplace, educational or care needs assessment, propose treatment and request payment for proposed services (for example case management, workplace rehabilitation).
You should also use this form to review the current treatment plan or to document case closure if the insurer requires it.
In some cases, an allied health practitioner might use this this form if additional information from the AHRR is requested by the insurer.
The fee for the payment of the rehabilitation services request needs to be agreed with the insurer before completion.
A Microsoft Word version of the rehabilitation services request form is available. Contact SIRA on 1300 137 131 to obtain a copy.
This form is only for NSW CTP personal injury claims.
The injured person may require various attendant care services to participate in usual activities, or to assist in their recovery.
Rehabilitation providers use the attendant care request form to request attendant care services. Some attendant care can be requested using the allied health recovery request, rehabilitation services request or via direct contact with the insurer (which is explained in further detail below).
The majority of people injured in motor vehicle accidents recover well and any need for attendant care is usually short term. Attendant care may not necessarily align to the injured person’s expectations; rather, it is provided to meet the injury related care need.
The injured persons care need and service requirement will usually change over time and reflect functional improvements. Subsequently, a review of the attendant care program should be scheduled as an integral part of the overall plan.
A plan for withdrawing attendant care as the person recovers is necessary to establish clear expectations for attendant care and its connection with recovery and treatment goals.
The following types of attendant care may be needed by a person while recovering from injury:
Educational and vocational support may also be provided but can only be requested by suitably qualified providers. Allied health practitioners should contact the insurer to discuss educational or vocational support needs. These should be considered in the rehabilitation services request.
Contact the CTP Green Slip insurer by phone when there is a need for attendant care, especially when an urgent need for attendant care arises. The CTP Green Slip insurer will advise how to proceed with a request for attendant care. This may be managed through an exchange of information such as emails or phone calls, particularly in the case of urgent attendant care needs.
If the attendant care need is anticipated or likely to be ongoing, the CTP Green Slip insurer may require service request forms (such as the allied health recovery request or rehabilitation services request) or the specific attendant care request.
The fee for completion of the attendant care request needs to be agreed with the insurer.
A Microsoft Word version of the attendant care request form is available. Contact SIRA on 1300 137 131 to obtain a copy.
This form is only for NSW CTP personal injury claims.
The injured person may require aids or equipment to support treatment, assist recovery or to compensate for a limitation caused by the compensable injury or injuries.
In general terms, there are three forms that can be used to request equipment. Which form to use depends on the individual circumstances. Contact the insurer for advice if the matter is urgent, or you are unsure which form to use.
Use the equipment request when recommending items that are:
Examples include shower or bath aids, a wheelchair for long-term use or home modifications.
Use the allied health recovery request (usually submitted by the allied health practitioner) or rehabilitation services request (usually submitted by the rehabilitation provider) when recommending items that are:
Examples include strapping tape, exercise putty, disposable electrodes, a boot or a walking stick, for injuries and related treatment that typically require such equipment.
If the insurer requires additional information they may decline the request, pending provision of the equipment request.
The fee for completion of the equipment request needs to be agreed with the CTP Green Slip insurer.
A Microsoft Word version of the equipment request form is available. Contact SIRA on 1300 137 131 to obtain a copy.
This form is only for NSW CTP personal injury claims.
If you need to contact the injured person's CTP Green Slip insurer, here are their details.
AAMI CTP Claims Department
Allianz CTP Claims Department
GIO CTP Claims Department
NRMA CTP Claims Department
QBE CTP Claims Department
Suncorp CTP Insurance
Zurich CTP Claims Department
To facilitate prompt payment, we suggest you:
Once a CTP Green Slip insurer has admitted liability, they are only obliged to pay for services that are reasonable and necessary.
If the insurer denies liability, the injured person is personally responsible for payment of accounts. They may be able to claim part or all of their expenses from Medicare, private health insurance, or from a personal accident insurance policy.
The CTP Green Slip insurer may agree, but is not obliged to pay for treatment on a ‘without prejudice’ basis before a decision is made on liability.
Without prejudice means that although the insurer has agreed to pay for treatment, it does not mean they are accepting liability for the accident or will pay for ongoing treatment once they have determined liability.
Agreement to pay without prejudice should be obtained in writing from the insurer before services are provided.
If you need to contact the injured person's CTP Green Slip insurer, their details are below. When you contact the CTP Green Slip insurer, you may speak to the following team members: claims officers (who manage the claim) or rehabilitation advisors/injury management advisors (who generally have allied health backgrounds to provide recommendations around injury management) or both.
AAMI CTP Claims Department
Allianz CTP Claims Department
GIO CTP Claims Department
NRMA CTP Claims Department
QBE CTP Claims Department
Suncorp CTP Insurance
Zurich CTP Claims Department
All allied health practitioners and rehabilitation providers must include the relevant service code(s) when requesting services using an allied health recovery request or rehabilitation services request.
Below is a list of the service codes.
Code | Name | Definition |
---|---|---|
201 | Assessment and management of work capacity, return to work, recover at work and return to education | Includes any assessment and management of work capacity, vocational rehabilitation, return to work/school. Can include job seeking and vocational retraining. This includes the assessment of the person’s work/school readiness and the work or education environment.Services can be provided by vocational rehabilitation provider, workplace rehabilitation provider, physiotherapist, occupational therapist, educational psychologist, case manager and others suitably qualified or experienced. |
Code | Name | Definition |
---|---|---|
301 | Physiotherapy services | Includes the assessment and therapy/treatment provided by a physiotherapist. Includes any interpreter costs to enable delivery of the service. Does not include when the physiotherapist is providing case management services. |
309 | Other assessment and treatment services | Includes the assessment and treatment services provided by an osteopath, chiropractor, massage therapist, acupuncturist, speech pathologist, occupational therapist, dietician, driving service and alternative therapy etc. (not covered by an existing code). Includes any interpreter costs to enable delivery of the service. Does not include when the allied health practitioner is providing case management services. |
310 | Exercise physiology services | Includes the assessment and therapy/treatment provided by an exercise physiologist. Includes any interpreter costs to enable delivery of the service. Does not include when the exercise physiologist is providing case management services. |
401 | Occupational therapy services | Includes the assessment and therapy/treatment provided by an occupational therapist. Includes any interpreter costs to enable delivery of the service. Does not include when the occupational therapist is providing case management services. |
402 | Psychology and counselling services | Includes the assessment and therapy/treatment provided by a psychologist or counsellor. Includes any interpreter costs to enable delivery of the service. Does not include when the psychologist or counsellor is providing case management services. |
406 | Pain management | This includes all interventions addressing chronic pain. |
702 | Equipment | Includes equipment that is provided as part of therapy and requires specific rationale. Usually requested using an equipment request and could include ADL aids, mobility aids, prostheses, etc. Does not include equipment requested in the AHRR to enable treatment (such as strapping tape, relaxation tape etc.). |
802 | Vehicle and home modifications | Includes all vehicle and home modifications prescribed by a suitably qualified allied health practitioner. |
Code | Name | Definition |
---|---|---|
501 | Case management services | Includes services provided to enable effective coordination of rehabilitation. Includes case conference and interpreter costs. |
505 | Reports | Includes documentation requested by the insurer and can include but is not limited to the AHRR, rehabilitation services request, attendant care request, equipment request. |
503 | Travel | Includes approved allied health practitioner/rehabilitation provider and claimant travel to enable delivery of the service. |
Code | Name | Definition |
---|---|---|
602 | Attendant Care | Includes personal assistance, nursing care, domestic services, community access, gardening home maintenance. |
The two main problems that can arise from time to time in the provision of services are:
There are several strategies to address these.
Unfortunately, not all cases progress as initially expected.
If functional improvement is slow or absent, the cause(s) should be identified and where appropriate, recovery expectations may need to be adjusted.
In some circumstances, it may be appropriate to recommend referral to another health care practitioner.
By discussing that option with the insurer, the injured person and their medical practitioner can help to change the intervention and seek better recovery outcomes.
Sometimes the insurer may not agree with the proposed direction for treatment. This can happen for a variety of reasons. If this occurs, there are several things that can be done.
Our website has more information on how we can help resolve disputes.
Our website has more information on how we can help resolve disputes.
When a CTP personal injury claim is submitted to the CTP Green Slip insurer, the injured person or their guardian signs a statutory declaration authorising the CTP Green Slip insurer to obtain information about the motor vehicle accident injury from treating medical practitioners and health providers.
The statutory declaration should give rehabilitation providers confidence that the insurer is only requesting access to information to which they are entitled, to make decisions about the injured person’s claim.
‘I authorise the Nominal Defendant or the insurer that this claim is made against (or an agent for the insurer) to: (i) contact and obtain information and documents relevant to the claim from persons specified in the authorisation (ii) to provide information and documents so obtained to persons specified in the authorisation
I understand that information obtained under this declaration from doctors, an ambulance service or as part of clinical notes from hospitals may include general medical information relevant to my claim.’