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).
If you're seeking physiotherapy approval under NSW Compulsory Third Party (CTP) laws, understanding what evidence insurers require is critical. This guide explains the specific documentation needed to support your claim, how SIRA guidelines apply, and steps to avoid disputes.
NSW CTP Rules Behind Physiotherapy Approval
Under the Motor Accident Injuries Act 2017, insurers must approve treatment that is 'reasonably necessary' for recovery. SIRA guidelines define what constitutes acceptable evidence for physiotherapy claims. Key principles include:
- Treatment must be directly related to the accident injury
- Evidence must show the treatment's necessity for recovery
- Documentation should align with SIRA's 'reasonably necessary' standard
Insurers typically require a medical practitioner's written approval, which must reference your specific injury and treatment plan. This is distinct from common law claims, where evidence standards differ.
Evidence and Records to Keep
To support your physiotherapy approval claim in Ashfield, retain these records:
- Medical reports: Include diagnosis, treatment plan, and how the therapy addresses your injury
- Physiotherapy records: Keep session notes, progress reports, and any correspondence with the therapist
- Accident documentation: Police reports, witness statements, and photos of the incident
- Income records: Show how the injury impacted your ability to work, if applicable
SIRA's 'What you can claim' page outlines that treatment must be 'reasonably necessary' and not excessive. For example, a therapist's note stating 'three sessions of manual therapy to address lumbar strain from the accident' would be stronger evidence than a vague statement.
Time Limits and When to Seek Advice
You have 52 weeks from the accident date to claim certain benefits under the Act. After this period, insurers may dispute treatment approvals unless you can demonstrate ongoing impairment. If your claim is denied, you may need to:
- Request a review of the insurer's decision
- Seek independent medical opinion
- Consider dispute resolution through NSW Civil and Administrative Tribunal (NCAT)
Common mistakes include failing to document the link between the accident and treatment, or not preserving records beyond the 52-week period. Always keep copies of all correspondence with insurers.
When to Contact Legal Advice
If your physiotherapy approval is denied and you're unsure how to proceed, seek guidance. Legal experts can help you:
- Challenge an insurer's refusal to approve treatment
- Navigate SIRA's complex documentation requirements
- Understand how your injury's severity affects eligibility
CTP claims depend on precise evidence. By maintaining thorough records and understanding SIRA's standards, you can strengthen your case.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.