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 treatment approval for a NSW Compulsory Third Party (CTP) claim, understanding what evidence insurers require is critical. Under NSW law, treatment must be approved by the insurer to be eligible for compensation. This article explains the records you should keep, how SIRA guidelines apply, and steps to support your claim in Ballina.
What Evidence is Required for Physiotherapy Approval?
NSW CTP insurers require clear evidence that your physiotherapy treatment is directly related to your injury from the accident. Key documents include:
- A medical report from a registered medical practitioner confirming your injury and treatment needs
- A treatment plan outlining the type, frequency, and duration of physiotherapy
- Written approval from the insurer confirming they've accepted the treatment
- Invoices or receipts showing payment for treatment
- Correspondence with the insurer showing you've sought approval
SIRA's guidelines state that treatment must be 'reasonably necessary' and 'directly related' to the injury. If your treatment isn't approved, you may need to resubmit with additional evidence.
Records to Keep for Your Claim
Maintain detailed records to support your claim:
- Medical records: Include all diagnostic reports, imaging results, and notes from your treating practitioner
- Accident details: Keep a copy of the police report, witness statements, and any accident scene photos
- Income records: Show how your injury has affected your ability to work
- Insurer communications: Save all emails, letters, and phone records with the insurer
- Treatment records: Document the dates, type, and progress of your physiotherapy sessions
If your treatment is denied, review the insurer's reasons and resubmit with additional evidence. SIRA's guidelines emphasize that treatment must be 'reasonably necessary' and 'directly related' to the injury.
Time Limits and Dispute Resolution
You must notify your insurer of your treatment intent within 52 weeks of the accident. If you fail to do so, you may lose entitlement to benefits for that treatment. Disputes over treatment approval should be resolved through the NSW Civil and Administrative Tribunal (NCAT) under the Motor Accident Injuries Act 2017. Always keep copies of all documents and seek advice if your claim is rejected.
When to Seek Legal Advice
If your insurer refuses to approve your treatment without a clear explanation, or if you're unsure about your entitlements, consult a legal professional. They can help you understand your options under NSW law and ensure you meet all requirements for treatment approval.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.