What Changed for Rehabilitation Providers in NSW CTP Claims After 2017?
The 2017 reforms to NSW’s Compulsory Third Party (CTP) insurance scheme significantly reshaped how rehabilitation providers are selected and approved. Prior to these changes, injured people had more flexibility in choosing treatment providers, but the new system introduced a formal process to ensure treatment is appropriate, evidence-based and aligned with recovery goals. The Motor Accident Injuries Act 2017 and the Motor Accident Injuries Regulation 2017 established a framework where only providers approved by the insurer or SIRA (the State Insurance Regulatory Authority) can deliver treatment under CTP. This change was designed to improve consistency, reduce duplication and ensure that rehabilitation services are delivered by qualified professionals under a regulated system.
How the 2017 Reforms Changed the Role of Rehabilitation Providers
Under the pre-2017 system, claimants could often choose their own physiotherapist, psychologist or exercise physiologist, with the insurer later reimbursing treatment costs. The 2017 reforms introduced a more structured approach. Now, claimants must be treated by a provider who is either:
- Approved by the CTP insurer, or
- Listed on the SIRA-approved provider list.
SIRA maintains a national register of approved rehabilitation providers, which includes professionals such as physiotherapists, exercise physiologists, psychologists and occupational therapists. These providers must meet specific qualifications and adhere to SIRA’s clinical standards. The insurer is responsible for approving treatment plans and ensuring that the provider is appropriately qualified and registered for the type of treatment required.
This shift means that claimants no longer have unrestricted choice. If a provider is not approved, the insurer is not required to fund treatment, even if it is medically necessary. This change aims to prevent inappropriate or ineffective treatment and to ensure that recovery is managed under a coordinated, evidence-based plan.
What Claimants Should Know About Provider Approval and Treatment
To access CTP-funded rehabilitation, a claimant must ensure that the provider they are using is on the SIRA-approved provider list or has been formally approved by their insurer. The insurer must notify the claimant in writing if a provider is not approved, and must provide a reason for the refusal.
Claimants who wish to use a provider not on the approved list may request approval from the insurer. The insurer must respond within 14 days. If the insurer refuses approval, the claimant may request a review by SIRA. SIRA has the authority to assess whether a provider meets the required standards and can override an insurer’s decision in certain circumstances.
For example, a chiropractor may be qualified but not listed on the SIRA register unless they meet the criteria for inclusion. Similarly, a psychologist must hold a current registration with AHPRA and have experience in treating trauma or injury-related psychological conditions to be eligible.
Evidence and Practical Steps to Support a Claim
To ensure a rehabilitation provider is approved and treatment is funded, claimants should:
- Confirm the provider’s name and registration number on the SIRA provider register at sira.nsw.gov.au.
- Request a written approval from the insurer before starting treatment.
- Keep copies of all correspondence, treatment plans, progress notes and invoices.
- Document any refusal of approval and the insurer’s response.
Photographs of the accident scene, witness contact details and medical reports from treating practitioners can also support a claim if disputes arise over provider approval or treatment necessity.
Time Limits and Dispute Options
There is no fixed deadline for requesting approval of a rehabilitation provider, but it is best to do so as soon as possible after the accident. Delays may affect the continuity of care and could impact the insurer’s ability to fund treatment if it is not provided in a timely manner.
If an insurer refuses approval for a provider, the claimant may request a review through SIRA’s dispute resolution process. SIRA can assess whether the provider meets the required standards and whether the refusal was reasonable. The claimant may also seek independent advice from a legal or claims professional to assist with the review.
A Realistic Example
A 38-year-old cyclist was injured in a motor vehicle accident in Sydney in June 2024. She was referred to a private physiotherapist who was not on the SIRA-approved list. The insurer refused to fund treatment, citing that the provider was not approved. The claimant contacted SIRA, submitted the provider’s qualifications and a treatment plan, and requested a review. SIRA determined that the provider met the required standards and directed the insurer to approve the treatment. The claimant was able to continue her rehabilitation without interruption.
Next Steps
The rules around approved rehabilitation providers in NSW CTP claims have become more structured since 2017. The system now prioritises qualified, registered professionals and ensures that treatment is coordinated under a formal approval process. However, claimants still have rights to challenge decisions and seek review through SIRA.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.