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).
Approved rehabilitation providers in New South Wales must maintain detailed records to support motor accident claims under the Compulsory Third Party (CTP) scheme. This article explains the legal requirements for documentation, referencing SIRA guidelines, and outlines what records are essential for claim success.
What Evidence Must Rehabilitation Providers Keep?
Under NSW CTP rules, rehabilitation providers must retain records that demonstrate the connection between the injury and the motor accident. Key documentation includes:
- Medical records showing diagnosis, treatment plans, and progress notes
- Treatment records detailing therapies, exercises, and equipment used
- Progress reports tracking improvements or setbacks
- Communication logs with the claimant, insurers, and other professionals
- Evidence of approval confirming the provider is on the insurer's approved list
SIRA guidelines emphasize that records must be contemporaneous, accurate, and directly relevant to the claim. For example, a physiotherapist must document how exercises address injuries caused by the accident, not general wellness goals.
How SIRA Guidelines Define Acceptable Records
SIRA's Motor Accident Claims page states that rehabilitation providers must:
- Maintain records for at least 5 years after the claim concludes
- Ensure all documentation is in English and legible
- Provide copies to insurers upon request
- Avoid altering records that could affect claim assessments
The guidelines also clarify that providers must confirm the claimant's injury aligns with the motor accident's impact. For instance, a provider treating a back injury must ensure the treatment plan addresses trauma from the accident, not pre-existing conditions.
Consequences of Poor Record-Keeping
Incomplete or poorly maintained records can lead to claim delays, disputes, or rejection. A hypothetical example: A claimant's physiotherapist fails to document how exercises target a specific spinal injury from the accident. This omission could result in the insurer disputing the treatment's relevance, potentially reducing compensation.
Time Limits and When to Seek Advice
Rehabilitation providers must submit records within 52 weeks of the accident if the claim involves only threshold injuries (soft tissue injuries meeting specific medical criteria). For more severe injuries, records should be submitted promptly to avoid issues with statutory benefits.
If disputes arise, providers should seek legal advice before making changes to records. Time limits for disputing decisions vary depending on the type of claim and when the issue was raised.
Next Steps
CTP claim outcomes depend on accurate documentation and compliance with SIRA standards. To discuss your specific circumstances, complete the quick, no obligation enquiry form. Every claim depends on its own facts.