Common Mistakes Claimants Make with Approved Rehabilitation Providers
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).
A threshold injury under the Motor Accident Injuries Act 2017 (NSW) includes a soft tissue injury and a psychological or psychiatric injury that is not a recognised psychiatric illness (adjustment disorder and acute stress disorder are the usual examples; s 1.6 and Motor Accident Guidelines Part 5).
In NSW, rehabilitation providers play a critical role in CTP claims, but claimants often make errors that delay or reduce their compensation. One frequent mistake is failing to confirm a provider is on the approved list. SIRA’s guidelines state that only approved providers can deliver treatment funded by the CTP scheme. Using an unapproved provider risks losing coverage for rehabilitation costs.
Another error is not following the correct documentation procedures. Claimants must ensure all treatment records, including therapy notes and progress reports, are submitted to their insurer. Missing or incomplete documentation can lead to disputes over the necessity of services.
Key CTP Rules Governing Rehabilitation Providers
Under the Motor Accident Injuries Act 2017, rehabilitation must be provided by a registered medical practitioner or approved allied health professional. SIRA’s guidelines clarify that providers must meet specific qualifications, such as being registered with the Australian Health Practitioners Regulatory Agency (AHPRA). Claimants should verify a provider’s credentials before starting treatment.
The CTP scheme also requires rehabilitation plans to align with the injured person’s recovery goals. For example, a physiotherapist must document how each session contributes to the claimant’s functional recovery. Failing to demonstrate this connection can result in denied claims for certain treatments.
Practical Steps to Avoid Disputes with Insurers
To ensure compliance, claimants should:
- Request written confirmation that their chosen provider is approved by SIRA.
- Keep detailed records of all treatment sessions, including dates, duration, and clinical notes.
- Submit progress reports to the insurer at least every three months.
- Communicate directly with the insurer if there are delays or changes to the treatment plan.
Insurers may challenge claims if providers are not following the CTP scheme’s rehabilitation protocols. For instance, a claimant who skips recommended therapy sessions without medical justification may lose coverage for additional treatments.
Time Limits and When to Seek Advice
Rehabilitation claims must be submitted within 52 weeks of the accident if the injury is classified as a threshold injury. For non-threshold injuries, there is no strict time limit, but delays can complicate claims. Claimants should seek legal advice if their insurer disputes the necessity of treatment or refuses to approve a provider.
In the Newcastle and Hunter regions, some claimants mistakenly assume that all local providers are automatically approved. However, SIRA’s website lists only approved providers, and regional areas may have fewer options. Seeking guidance from a solicitor or SIRA’s helpline can prevent costly errors.
Example of a Common Error
A claimant in Newcastle once missed a key deadline by not submitting a physiotherapist’s report within the 52-week window. The insurer denied coverage for the remaining sessions, even though the claimant had completed most of the therapy. This highlights the importance of tracking time-sensitive requirements.
Next Steps for Claimants
If you’ve made a mistake with your rehabilitation provider or are unsure about your options, contact a legal professional. While this article provides general guidance, your circumstances may require tailored advice. Time limits and procedural rules can vary based on the accident date and injury type.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.