Physiotherapy Approval, What Changed After 2017 Reforms in NSW
Where a person's only injuries resulting from the accident are threshold injuries, weekly benefits and treatment and care generally cease after 52 weeks (ss 3.11 and 3.28).
Under the NSW Compulsory Third Party (CTP) scheme, claimants must now obtain approval for physiotherapy treatments before accessing compensation. The 2017 reforms to the Motor Accident Injuries Act 2017 (MAIA) shifted the focus from fault-based claims to a no-fault system, altering how treatment approvals are handled. This article explains the changes, the process for securing approval, and the criteria used by the State Insurance Regulatory Authority (SIRA) to assess treatment necessity.
Key Changes to Physiotherapy Approval Under NSW CTP Rules
Before 2017, claimants could claim compensation for injuries regardless of fault, but treatment approvals were less structured. Under the new system, claimants must submit a treatment plan to SIRA for approval. This plan must be signed by a medical practitioner and outline the necessity of physiotherapy for recovery. SIRA evaluates whether the treatment aligns with the injury’s severity and expected recovery timeline.
The reforms also introduced stricter criteria for approving long-term treatments. For example, soft tissue injuries (like whiplash) now require evidence of neurological signs or spinal nerve-root damage to qualify for ongoing physiotherapy. This change ensures that only treatments deemed medically necessary are approved, reducing the risk of overclaiming.
How to Apply for Approved Physiotherapy Treatments
To apply, claimants must:
- Notify SIRA of their intention to seek physiotherapy treatment within 52 weeks of the accident.
- Submit a signed treatment plan from a medical practitioner, detailing the treatment’s purpose and expected outcomes.
- Provide medical records confirming the injury’s link to the accident.
SIRA reviews the application within 28 days. If approved, the claimant can access the treatment, and the cost is covered by the at-fault driver’s insurer. If denied, the claimant may request a review or seek independent medical advice.
SIRA’s Criteria for Assessing Treatment Requests
SIRA evaluates treatment requests based on:
- Medical necessity: Is the physiotherapy treatment essential for recovery, or is it for symptom management only?
- Evidence of injury: Does the treatment plan align with the documented injury (e.g., soft tissue injury, spinal damage)?
- Recovery timeline: Does the treatment plan match the expected recovery period for the injury?
For example, a claimant with a soft tissue injury requiring 12 weeks of physiotherapy must demonstrate that the treatment is necessary for full recovery, not just to manage pain. SIRA may reject requests for treatments that are not directly tied to the injury’s severity.
Practical Steps and Evidence to Gather
Claimants should:
- Document all medical interactions and keep copies of treatment plans.
- Photograph injuries and note symptoms to support the treatment plan.
- Keep records of all correspondence with SIRA or insurers.
If a claim is denied, the claimant may request a review by SIRA or seek legal advice to challenge the decision. It is important to act promptly, as time limits apply to certain benefits.
When to Seek Legal Advice
If a claimant is unsure whether their treatment meets SIRA’s criteria, or if their application has been denied, they should consult a legal professional. A solicitor can help challenge a decision or ensure all requirements are met.
Next Steps
The process for obtaining physiotherapy approval under NSW CTP claims has evolved since 2017. Understanding the new rules and gathering the right evidence is critical to securing treatment. Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.