SIRA News

Cessation of entitlements

As a result of the application of section 59A of the Workers Compensation Act 1987, one or more of your patients may soon no longer have their claim for medical, hospital and rehabilitation expenses compensated through the workers compensation system. They may need your assistance to prepare for this change.

The date these changes come into effect will vary, with some patients ceasing entitlements from September 2019.

If you are providing treatment/services to a patient(s) affected by these changes, you should gain a clear understanding from each patient when their entitlements will cease and let them know the costs of any treatment/services provided after that date will be their responsibility.

Treatments/services provided after the cessation date will not be paid by the insurer, even when previously approved.

SIRA suggests you tailor your approach to affected patients and work collaboratively with insurer case managers to ensure patients receive appropriate support before their entitlements end.

You might consider actions to:

• discuss and inform your patients of medical and support services available to them and make referrals where appropriate. This could include through publicly-funded community, state or federal systems, or where applicable, services funded by private health insurers.
• prepare a discharge plan with your patients with the goal of developing self-management strategies to promote independence from health care. This will assist them with longer-term management of their injury or condition.

For more information, look online for the Section 59A Information for health providers fact sheet, visit www.sira.nsw.gov.au or contact the patient’s workers compensation insurer case manager.

Maximum fees for medical services

SIRA is reminding medical practitioners about the prescribed fees for services relating to workers compensation and motor accidents (CTP) claims.

Medical practitioners should charge no more than the prescribed fees, which are set in law or by the Australian Medical Association and differ between the CTP and workers compensation schemes.

SIRA has identified overcharging as an emerging issue in complaints from scheme participants and analysis of payment summary reports.

To avoid overcharging, you are encouraged to check whether patients have active workers compensation or CTP claims and charge no more than the maximum fee.

Insurers should not pay more than the maximum prescribed fees for these medical services, and an injured person is not to be charged a gap.

For more information, visit the SIRA website.

Assessors of permanent impairment needed

SIRA Workers Compensation are inviting specialist medical practitioners to become assessors of permanent impairment in the NSW workers compensation system in following areas:

• Haematopoietic
• Endocrine
• Cardiology
• Urinary and Reproductive system (gynaecology)

SIRA currently has insufficient assessors to meet demand in the above areas, particularly for the haematopoietic system. The introduction of the Workers Compensation Legislation Amendment (Firefighters) Bill 2018 has increased demand for assessors in this area, as the presumptive legislation covers 3 blood cancers (Leukemia, non-Hodgkin’s lymphoma and multiple myeloma).

Prior to applying to become an assessor with SIRA, medical practitioners are required to undertake training in the evaluation of permanent impairment using the NSW workers-compensation-guidelines-for-the-evaluation-of-permanent-impairment 4th ed through AMA Training. Information about the training is available at http://ama5.com.au/.  Following successful completion of the training all doctors need to apply to SIRA Workers Compensation to be listed on the SIRA website to conduct assessments with workers. The requirements to be eligible to be listed as a trained assessor of permanent impairment with SIRA Workers Compensation are available through the SIRA website.

Please contact Maria Wilson at maria.wilson@sira.nsw.gov.au or by telephone at 9282 5870 for further information.