Workers compensation workplace rehabilitation provider approval framework

This framework sets out the requirements for organisations delivering or seeking to deliver workplace rehabilitation services within the NSW Workers Compensation Scheme.

5. Part 5 The application and approval process

In NSW, for organisations to deliver workplace rehabilitation services within the workers compensation scheme, they must be approved as a workplace rehabilitation provider (provider) by SIRA under section 52(4)(c) of the 1998 Act.

Application for approval

Prior to applying for SIRA approval, an applicant should read all parts of the framework to prepare their application and determine if they can meet and adhere to the conditions of approval.

Applicants seeking approval are to submit an Application for Approval as a Workplace Rehabilitation Provider form together with:

the proposed service delivery model
business and ownership details including association or connection with other organisations supplying services within the workers compensation industry, declaring conflicts of interest whether perceived, potential or actual, and other relevant details
a completed workplace rehabilitation provider staff details form including qualifications and services delivered by each staff member who will deliver workplace rehabilitation services to workers
details of a contact person who will communicate with SIRA and be required to have authority to make decisions on behalf of the applicant and be the direct link to communicate any issues to SIRA.

A completed application must be accompanied by the application fee prescribed by SIRA.

It is recommended that applicants submit their applications in October to December for SIRA assessment from 1 January to 30 March of the following year. Applications to be a SIRA approved workplace rehabilitation provider can be received up to 30 March.

Where the provider applies in the final year of a three-year approval period, they will be required to reapply the following year for the entire three-year approval period, including paying the required application fee.

The workers compensation legislation provides for criminal penalties for a person who commits fraud against the worker compensation legislation (s235A of the 1998 Act) or knowingly makes a false or misleading statement relating to a claim (s235C of the 1998 Act).

SIRA will assess new applications for approval as a workplace rehabilitation provider between 1 January to 30 March each year and will decide on an application within four months after the date of lodgement of the application.

SIRA will only assess applications outside this timeframe if SIRA has identified a need for new providers to work within the scheme. If this occurs, industry will be notified via the SIRA website.

The assessment process

SIRA will assess the suitability of the applicant to deliver safe and high-quality workplace rehabilitation services, including consideration of:

whether the director is a fit and proper person to hold the certificate of approval
the applicant’s capacity to meet and continue to meet the regulatory requirements and conditions of approval

whether the organisation has previously been an approved provider
previous complaints raised with SIRA regarding the applicant
the findings of completed workplace rehabilitation provider evaluation/s and outcome report/s and the provider's annual report/s (where available)
the applicant’s performance in relation to service costs and return to work outcomes
data SIRA holds and receives from other stakeholders (including insurers, employers and stakeholders)

any other information that SIRA has concerning the provider relevant to workplace rehabilitation service provision.

Upon receipt of an application for approval, SIRA will conduct a preliminary review of the application to ensure that all the required documentation has been completed and the application meets the requirements.

Incomplete applications cannot be assessed. If SIRA receives an incomplete application, the organisation will be given an opportunity to submit the required information providing the information can be assessed within the assessment period. If the information is not received, the application cannot proceed, and the organisation will be notified. Should the organisation wish to apply again, it will need to do so in the next approval round.

Complete applications will be reviewed and assessed by SIRA in line with the workers compensation legislation and conditions of approval.

SIRA will review the documentation and contact the applicant's nominated contact person to clarify any aspect of the application.

Certificate of approval

If an application for approval is successful, SIRA will issue a certificate of approval to the applicant for a period of up to three years (until 31 December of the third year of the approval period).

The certificate of approval will contain:

the name of the provider business
the date of issue and expiry
a statement that the provider business is an approved workplace rehabilitation provider
the permitted service stream/s the provider is approved to deliver.

References to a certificate of approval for advertising purposes should be limited to the information contained on the approval certificate. Where a statement is made, it should read as follows:

'This organisation is approved by SIRA to provide workplace rehabilitation services within the NSW workers compensation system.'

Possession of a valid certificate of approval is subject to the provider's continued conformance with the conditions of approval.

Declination of approval

Where SIRA refuses to grant or amend the certificate of approval, the applicant will be provided with an outcome of assessment letter detailing the conditions of approval that were not met.

Appealing the outcome of an assessment

If an applicant wishes to appeal the outcome of assessment, they must submit a written appeal and address the issues raised in the outcome of assessment letter, with specific reference to the conditions of approval that were not met.

Appeal correspondence should be addressed to Director, Health Policy, Prevention and Supervision, State Insurance Regulatory Authority.
Emailed to: [email protected]

The appeal will be assessed by an independent review officer who was not involved in the original assessment decision.

The applicant will be advised of the outcome and reasons for the appeal decision in writing.

Approval to deliver additional permitted service stream

Approved providers who wish to deliver additionally permitted service stream/s must submit an application addressing the relevant conditions of approval.

Approval to operate at additional sites

Approved providers who wish to be granted an additional approval number for a new site should submit a completed Approval to operate at additional sites form to [email protected]

Ceasing or withdrawing from service delivery

Providers who wish to cease or withdraw from delivering workplace rehabilitation services in NSW must, as soon as practicable, inform SIRA in writing prior to ceasing service delivery.

Prior to ceasing or withdrawing from delivering services, SIRA will require that providers cooperate in the transfer of current cases to other providers.