If you're seeking physiotherapy treatment approval for your NSW CTP claim, understanding what evidence insurers require is critical. Under the Motor Accident Injuries Act 2017 (MAIA), insurers must approve treatment plans that align with the injury's severity and medical necessity. This article explains the records you must keep, how they are used by insurers, and how SIRA guidelines apply to this process.
Evidence Required for Physiotherapy Approval
Insurers assess whether physiotherapy is medically necessary by reviewing clinical evidence. Key documents include:
- Medical reports from a registered medical practitioner confirming the injury's nature, treatment plan, and expected outcomes.
- Physiotherapy referral notes detailing the specific exercises, duration, and frequency of treatment.
- Progress records showing how the treatment addresses your injury and improves your condition.
- Statements from your treating doctor confirming the treatment's necessity and alignment with your injury.
SIRA guidelines emphasize that insurers must approve treatment that is 'reasonably necessary' for recovery. If your physiotherapist's plan lacks clinical justification, insurers may dispute approval.
Retention Period for Records
Under the MAIA, weekly benefits and treatment benefits are generally limited to 52 weeks if your injuries are classified as 'threshold injuries' (soft tissue injuries meeting specific neurological criteria). While there is no universal retention period for physiotherapy records, insurers may challenge claims where records are incomplete or lack continuity beyond 52 weeks. For example, if your treatment plan exceeds 52 weeks without evidence of ongoing impairment, insurers may argue it falls outside the statutory benefit period.
Consequences of Missing Records
Incomplete records can lead to disputes. If you fail to provide:
- A clear link between the injury and the physiotherapy plan,
- Evidence of how the treatment addresses your specific condition,
- Documentation showing the treatment's necessity,
insurers may refuse approval or reduce benefits. For instance, a claimant who only provides a generic referral note without clinical details may struggle to prove the treatment's relevance to their injury.
SIRA Guidelines Application
SIRA's guidance on 'what you can claim' clarifies that physiotherapy must be 'reasonably necessary' and 'directly related to the injury.' This means:
- Treatment must be prescribed by a medical practitioner,
- The plan must align with the injury's severity and recovery prognosis,
- Records must demonstrate the treatment's role in managing the injury.
SIRA also notes that insurers must approve treatment within 28 days of receiving the claimant's request, though this timeline may vary depending on the complexity of the case.
When to Seek Advice
If you're unsure whether your physiotherapy records meet insurer requirements, seek legal advice. A solicitor can help you:
- Review your medical records for compliance with SIRA guidelines,
- Challenge an insurer's refusal to approve treatment,
- Understand how time limits apply to your specific case.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.