Waiting for CTP treatment approval in NSW
Treatment approvals involve your insurer and treating provider working from a clear picture of the care recommended for you. If you are waiting for CTP treatment approval in NSW, a conversation with your team can help you understand the next step.
This guide is for insurer-managed claims arising from NSW motor accidents on or after 1 December 2017.
Help your team understand the request
Your treating provider can explain the proposed treatment, its goals and how it relates to your recovery. The insurer uses relevant clinical information and costs to consider funding under the claim.
If you are unsure what happens next, you could ask your provider:
- Has the treatment request been sent to the insurer?
- What treatment or sessions are being proposed?
- Is there anything you need from me to help explain my current needs?
SIRA's medical-expenses guidance explains that funding relates to reasonable and necessary expenses arising from the crash.
Stay in touch about timing
A brief check-in with your insurer can clarify whether the request has arrived, whether anything needs clarification and when you can expect a decision. Mention any upcoming appointment so everyone understands the arrangements being considered.
Insurers generally have 10 days to respond after receiving a request for treatment funding. See SIRA's Motor Accident Guidelines. Your provider can help confirm when the request was submitted.
While the request is being considered, check the funding arrangements before assuming a planned service will be covered.
Understand the approved plan
When a response arrives, read it with your provider. Useful questions include:
- Which services, sessions and fees have been approved?
- Are there any dates or conditions we should keep in mind?
- Will the provider bill the insurer directly, or could I have costs to pay?
- When should we review progress and consider whether further treatment is needed?
If only part of the request is approved, ask your insurer to explain the decision and discuss it with your treating provider. They can consider whether clarification or further clinical information would help. If concerns remain, you can ask about the available review options and any relevant deadlines.
Keep your treating team updated
Tell your practitioner if symptoms change or you are concerned about waiting. For immediate health advice, healthdirect is available on 1800 022 222. Call 000 for a life-threatening emergency; do not wait for a funding response.
How COH Rehab can help
If coordinating appointments or everyday recovery needs is becoming difficult, ask your doctor and insurer whether rehabilitation support would be useful.
COH Rehab can coordinate agreed rehabilitation services with your treating team, with the required referral, consent and insurer-approved scope. Insurer approval is needed before rehabilitation-provider services begin, including the initial assessment. Our CTP rehabilitation process guide explains what to expect.
Enquire about CTP rehabilitation with COH Rehab to discuss the coordination support you need. You can also read about the roles of a GP and rehabilitation provider.
General information only. Your treating practitioner advises on medical care; your insurer determines funding. COH Rehab does not provide legal advice.