Allied health practitioners
Allied health practitioners
Allied health practitioners are health professionals engaged to help workers recover from a work-related injury/illness.
The allied health practitioners most commonly involved in workers compensation claims include (but are not limited to):
- exercise physiologists
In order to deliver treatment services in the NSW workers compensation system, the allied health practitioners listed above must be approved by SIRA. Approved practitioners are issued a provider number.
Exempt workers are not required to use SIRA-approved physiotherapists, chiropractors, osteopaths, exercise physiologists, psychologists and counsellors.
Other allied health practitioners such as podiatrists, occupational therapists, massage therapists and hearing service providers do not require SIRA approval.
The role of allied health practitioners
Allied health practitioners use evidence-based clinical intervention (treatment) and management to help the worker in their recovery at/return to work. The allied health practitioner’s role may include:
- conducting a detailed assessment of the worker and (where applicable) providing information to inform and/or confirm diagnosis, and develop and implement treatment strategies
- obtaining information from the worker, insurer and/or employer to help with goal-setting and treatment interventions
- treating the worker in accordance with the Clinical framework for the delivery of health services
- setting expectations regarding recovery at/return to work, active participation in recovery, planning and treatment
- using the allied health recovery request (see ‘Communication with allied health practitioners’ below) to inform the insurer of the worker’s progress and capacity for work
- educating all parties about the health benefits of good work.
Clinical framework for the delivery of health services
Allied health practitioners should provide health services in accordance with the Clinical framework for the delivery of health services. The framework outlines a set of guiding principles intended to support healthcare professionals in their treatment of an injury through:
- measurement and demonstration of the effectiveness of treatment
- the adoption of a biopsychosocial approach
- empowering the worker to manage their injury
- implementing goals focused on optimising function, participation and return to work
- basing treatment on the best available research evidence.
Note: The allied health practitioner, while supporting and encouraging the worker in their recovery, should not advocate for the worker in relation to the management of their claim, litigation or other compensation processes.
Communication with allied health practitioners
The allied health recovery request (AHRR) is the primary communication tool for allied health practitioners to inform the support team of the worker’s recovery and the provision of services.
The AHRR allows allied health practitioners to:
- describe the impact of the injury on the worker in terms of reported and observed signs and symptoms, as well as their capacity to engage in their roles at work, home and in the community
- set goals and empower the worker to be actively involved in their recovery
- outline an action plan
- demonstrate the effectiveness of treatment using measurable outcomes
- request approval of treatment services, including equipment needs and case conferencing
- indicate the anticipated timeframe for recovery
- receive an insurer decision to their treatment request.
Practitioners can request approval for up to eight treatment services on a single AHRR form. However, they should only request the number of sessions they believe the worker will need.
Questions about treatment
If an insurer has concerns regarding the duration, frequency, or nature of the treatment, or whether it is reasonably necessary, they may contact the allied health practitioner directly to discuss the issue. If this does not resolve the issue, a referral can be made to an independent consultant.
An independent consultant is an allied health practitioner approved by SIRA to provide an independent peer review of allied health practitioner treatment (either physical or psychological). They can be called on to provide expert opinion or advice regarding treatment and any barriers to the worker’s recovery. See 'Independent consultants'.
Insurers must use the independent consultant referral form to engage an independent consultant.
Fees and invoicing
Fees for allied health providers are set out in the relevant Fees Orders found on the SIRA website.
The Fees Order specifies how much can be charged and what codes providers are to use. Fees Orders specify the maximum amount payable per service and any service restrictions, and reiterate that workers are not liable for these costs.
No fees are payable for cancellation or non-attendances. Pre-payment of fees for reports or services is not permitted.
Note: In response to the COVID-19 (Coronavirus) pandemic, telehealth services have been expanded to include the delivery of allied health consultations via telephone and video technology, if appropriate. New payment classification codes for telehealth consultations have been included in the relevant Fees Orders.
Invoices should include:
- the worker's first and last name, and claim number
- the date of invoice (must be on the day of or after last date of service listed on the invoice)
- the date of service
- name and ABN of the medical practitioner or service provider who provided the service
- payee details
- SIRA workers compensation approval number or medical practitioner's Health Insurance Commission provider number (where applicable)
- SIRA workers compensation payment classification code or AMA item number where applicable. Refer to the relevant Fees Order on the SIRA website and the Workers compensation insurer data reporting requirements
- service cost for each SIRA workers compensation payment classification code or AMA item number and service duration (if applicable).
To prevent delays in payment, these details need to be provided on all invoices.
Treatment provided by an allied health professional other than a physiotherapist, chiropractor, osteopath, exercise physiologist, psychologist, counsellor or massage therapist is not covered by a Fees Order.
The insurer should negotiate an appropriate fee prior to the commencement of treatment, taking into account existing Fees Orders, and what would be customarily paid in the community.
Interstate allied health practitioners
Sometimes NSW workers may be treated by interstate providers. Even though they are in a different state, these providers must adhere to the NSW workers compensation system requirements.
NSW legislation states that interstate treatment providers delivering services to NSW workers do not need to be approved by SIRA, however, they do need to meet the approval criteria (other than the requirement to complete the NSW allied health practitioner training).
Interstate treatment providers cannot access exemptions from prior approval unless the treatment is provided within 48 hours of the injury occurring.
Interstate practitioners should use the service provider code ‘INT0000’ when invoicing. Fees charged cannot exceed the maximum fee payable in NSW.
- Workers compensation guide for allied health practitioners
- Workers compensation insurer data reporting requirements
- Clinical Framework for the Delivery of Health Services
- Fees and rates orders
- Independent consultants referral form
- Allied health recovery request
- SIRA approved provider search
- Realising the health benefits of good work