Physiotherapy Approval and Time Limits in NSW CTP Claims
If you’ve been injured in a motor accident in Greater Sydney, you may need physiotherapy to recover. Under the Motor Accident Injuries Act 2017 (NSW), your insurer must approve treatment like physiotherapy if it is reasonable and necessary for your recovery. However, approval must be sought within a timeframe that can affect your access to care.
There is no fixed statutory deadline for requesting physiotherapy approval under NSW law. But delays in notifying your insurer or failing to seek approval promptly may impact the insurer’s ability to assess and approve the treatment. The insurer must respond to a treatment request within 14 days of receiving it, and if they fail to respond, the treatment may still be approved under the Motor Accident Injuries Regulation 2017.
The key point is not a calendar deadline, but the need to act promptly after the accident. Delays in reporting injuries or requesting treatment may affect the insurer’s assessment of whether the treatment is reasonable and necessary, particularly if the injury is not immediately apparent.
How NSW CTP Rules Apply to Physiotherapy Treatment
Under the Motor Accident Injuries Act 2017, you are entitled to treatment and care benefits, including physiotherapy, if it is reasonable and necessary for your recovery from injuries sustained in a motor accident. These benefits are not dependent on fault and are available to drivers, passengers, pedestrians, cyclists and motorcyclists.
The insurer must approve treatment that is recommended by a medical practitioner or allied health professional, provided it is consistent with the Motor Accident Injuries Guidelines. These guidelines set standards for treatment, including physiotherapy, and require that treatment be evidence-based, clinically appropriate and proportionate to the injury.
If your injury is classified as a threshold injury (such as a soft tissue injury), treatment may still be approved, but the insurer may apply limits on the duration of treatment and care benefits after 52 weeks, unless the injury results in a permanent impairment or a more serious condition.
Practical Steps to Secure Physiotherapy Approval
To increase the likelihood of timely approval for physiotherapy, follow these steps:
- Seek medical attention as soon as possible after the accident. A medical practitioner’s report will support your claim for treatment.
- Provide your insurer with a written request for physiotherapy, including a recommendation from a physiotherapist or medical practitioner.
- Keep copies of all correspondence, including emails, letters, and treatment plans.
- Retain records of all appointments, including dates, times, and notes from the physiotherapist.
- If your insurer refuses approval, ask for a written explanation and request a review.
Insurers are required to assess treatment requests within 14 days. If they do not respond within that time, you may proceed with treatment and later claim reimbursement. However, it is best to avoid delays that could complicate the approval process.
Time Limits and the 52-Week Rule
There is no separate time limit for approving physiotherapy itself. However, the 52-week rule under the Motor Accident Injuries Act 2017 may affect treatment duration. If your only injuries are threshold injuries, treatment and care benefits (including physiotherapy) are generally limited to 52 weeks from the date of the accident.
This means that while approval for physiotherapy can be sought at any time, the insurer may stop funding treatment after 52 weeks if no higher-level injury or permanent impairment is established. If you are still receiving treatment beyond that point, you must demonstrate that the treatment remains reasonable and necessary, and that your injury has not resolved.
The 52-week limit does not apply if you have a whole person impairment (WPI) of 10% or more, or if your injury includes a non-threshold condition such as a spinal nerve-root injury with neurological signs (other than radiculopathy) as defined in the Motor Accident Injuries Guidelines.
What to Do If Approval Is Denied
If your insurer refuses to approve physiotherapy, you can request a review under the insurer’s internal dispute resolution process. If the dispute remains unresolved, you may refer the matter to the State Insurance Regulatory Authority (SIRA) for review.
SIRA has the authority to determine whether treatment is reasonable and necessary. You may also seek a second opinion from a medical practitioner or allied health professional to support your case.
A common example: A pedestrian in Sydney was injured in a car-pedestrian collision in June 2024. They began physiotherapy in August 2024, but the insurer delayed approval until November 2024. The treatment was eventually approved, but the delay caused a gap in care. In this case, the claimant was able to claim reimbursement for the treatment received during the delay, provided they had documented the treatment and insurer’s failure to respond.
When to Seek Independent Advice
The process for approving treatment can be complex, particularly if your injury is not immediately apparent or if the insurer disputes the need for treatment. If you are unsure whether your treatment is eligible, or if approval is delayed or denied, it is advisable to seek independent legal or medical advice.
The nature of your injury, the timing of treatment, and the insurer’s response will all influence whether approval is granted. A delay in treatment may affect the insurer’s assessment of whether it was reasonable and necessary, particularly if the injury has not been properly documented.
Next Steps
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.