Injured people in Bankstown seeking physiotherapy treatment under NSW Compulsory Third Party (CTP) laws must understand how SIRA approves treatment requests. Approval depends on medical necessity, documented evidence of injury, and compliance with the Motor Accident Guidelines. This article explains the process, required documentation, and steps to take if a claim is denied.
How SIRA Approves Physiotherapy Treatment Requests
SIRA evaluates treatment approvals based on the Motor Accident Guidelines and the Motor Accident Injuries Act 2017. To qualify, the treatment must be:
- Medically necessary to address the injury caused by the motor accident.
- Supported by a medical practitioner’s assessment (e.g., a GP or physiotherapist).
- Included in the treatment plan provided to SIRA.
Physiotherapy is typically approved if it addresses soft tissue injuries, spinal issues, or mobility restrictions resulting from the accident. However, SIRA may deny claims if the treatment is deemed unnecessary, not evidence-based, or not aligned with the injury’s severity.
Documentation Required for Approval
To support a physiotherapy treatment request, injured people must provide:
- Medical records confirming the injury (e.g., X-rays, MRI scans, or clinical notes).
- A detailed treatment plan from the physiotherapist, including the type of therapy, frequency, and expected outcomes.
- Evidence of the accident (e.g., police report, witness statements, or accident report).
- Proof of treatment commencement (e.g., invoices or session logs).
SIRA may request additional information if the treatment plan lacks clarity or if the injury’s severity is disputed.
Approval Timelines and Dispute Options
SIRA typically takes up to 28 days to approve or deny a treatment request after receiving all required documentation. If a claim is denied, injured people can:
- Request a review by submitting additional evidence or clarification.
- Appeal through the NSW Civil and Administrative Tribunal (NCAT) if the decision is unsatisfactory.
It’s important to note that the 52-week statutory benefit period under the Motor Accident Injuries Act 2017 may affect long-term treatment approvals. After 52 weeks, weekly benefits are generally limited to threshold injuries, though ongoing physiotherapy may still be approved if it addresses a specific, documented need.
What to Do If Treatment Is Denied
If SIRA denies a physiotherapy claim, injured people should:
- Review the rejection letter to understand the reason.
- Consult a medical practitioner to confirm the treatment’s necessity.
- Seek legal advice if the denial appears unjustified or if there are disputes over the injury’s severity.
In Bankstown, many injured individuals find it helpful to work with a solicitor experienced in CTP claims to navigate the approval process and ensure their rights are protected.
When to Seek Legal Advice
Legal assistance is recommended if:
- The injury’s severity or treatment needs are disputed.
- SIRA denies a claim without clear reasoning.
- The injured person is unsure how to respond to a rejection.
A solicitor can help challenge a decision, ensure all documentation is submitted correctly, and advise on options for dispute resolution.
Summary of Key Steps
- Provide medical evidence of the injury.
- Submit a detailed treatment plan.
- Await SIRA’s decision within 28 days.
- Request a review or seek legal advice if denied.
Time limits and procedural requirements may apply. To request contact about your circumstances, complete the quick, no obligation enquiry form.