The short version
Approval is a document, not a mood
A NSW CTP insurer does not fund treatment because you asked nicely, and it does not stop funding treatment because somebody decided you had had enough. It funds treatment that passes a written test, described in a written request, inside a deadline. When physiotherapy stalls, one of those three things has gone wrong, and almost always it is the request. Understanding the shape of the process is the difference between chasing a claims officer for a fortnight and knowing exactly which document is missing.
Everything below applies to statutory benefits under the Motor Accident Injuries Act 2017, which is the part of the CTP scheme that pays for your treatment and your time off work. It applies whether or not the crash was your fault. If you have not seen anyone yet, start with our car accident injury service, where our doctors and physiotherapists pick this up from the first appointment.
1. The five-part test your physio has to pass
Section 3.24(1)(a) of the Act entitles you to the reasonable cost of treatment and care relating to your injury. Section 3.24(2) is the limit on it: an insurer is not liable for cost that was not reasonable and necessary in the circumstances, or that did not relate to the injury. Everything else is interpretation, and SIRA publishes the interpretation insurers work to. Five things have to be true of any treatment before a CTP insurer funds it.
- ✓It is directly related to the injuries you sustained in the crash.
- ✓It is aimed at helping you get back to your usual activities.
- ✓It is appropriate for the type of injury you have.
- ✓It is provided by an appropriately qualified health professional.
- ✓It is cost effective.
Read them again with a claims officer’s eyes. Three of the five are answered by clinical notes rather than by anything you can say on the phone. Whether treatment is appropriate for the injury, whether it is aimed at getting you back to normal life, and whether it is cost effective are all judgements about what your practitioner wrote down. That is the whole game.
Source: SIRA, Fees paid for motor crash health services (updated 18 September 2025); Motor Accident Injuries Act 2017 s 3.24. Checked September 2026.
2. The one session that does not need approval
There is a sensible carve-out at the front of the process. One initial allied health assessment on a lodged claim is exempt from pre-approval. A physiotherapist or psychologist can see you, examine you and work out what you actually need without first asking permission to look at you. The condition is that you already hold a CTP claim number, because the insurer needs something to record the session against.
Before a claim exists there is a narrower allowance again. For the first 28 days after a crash the Guidelines let an insurer pay for a doctor’s appointment and two allied health treatment sessions in advance of any claim. Three conditions attach: the insurer has to agree, it has to be notified so that a claim or reference number exists, and nothing is available under this heading past day 28. Once that window closes, a statutory benefits claim has to be made before anyone treats you at the insurer’s expense. If you are inside that first month, our first 72 hours guide runs through the sequence in order.
Source: SIRA, Motor Accident Guidelines 4.78–4.79; SIRA, Providing allied health services in the NSW CTP schemes — FAQs. Checked September 2026.
3. The request that follows your first session
Everything past the initial assessment is approved in advance, session block by session block. After that first appointment your practitioner sends the insurer a treatment request. You may hear it called an allied health treatment request or an allied health recovery request; SIRA and the insurers use both names for the same document, so ask your claims officer which form they want if there is any doubt.
A request that gets approved without an argument does four things. It names the injury and the examination findings that establish it. It states what the treatment is for in terms of your ordinary life, which might be driving to work, lifting a toddler or sleeping through the night. It asks for a defined number of sessions over a defined period rather than an open tab. And it sets a point at which the practitioner will reassess and report back. A request that gets queried usually does none of those things and simply asks for more of what has already been happening.
Sitting behind all of this is your recovery plan, which the insurer is to complete within 28 days of the claim being made and review at least every 12 weeks. It has to take account of the information your treating providers give the insurer, which is another reason a practitioner who replies to insurer correspondence promptly is worth more to your claim than one who does not.
Source: SIRA, Motor Accident Guidelines 4.87, 4.90, 4.92 and 4.93; SIRA allied health CTP FAQs. Checked September 2026.
4. Ten days to answer, twenty days to pay
Once the request lands, the insurer is on a clock. Clause 4.106 of the Motor Accident Guidelines requires a decision as soon as possible and no later than 10 days from receipt of the request. Where the request is approved and your practitioner invoices, the account is to be paid within 20 days of the invoice being received. Those two numbers are the ones worth memorising, because they turn a vague sense of being ignored into a specific question you can put to a claims officer.
A third deadline sits underneath both. If the insurer has not yet told you whether it accepts liability for your statutory benefits during the first 52 weeks, section 6.19(1) gives it four weeks from the claim to do so. Where the insurer fails to notify you in accordance with that section, it is taken to have accepted liability. A treatment request submitted while liability is undecided is not lost; it is queued behind a decision that is itself on a deadline.
Source: SIRA, Motor Accident Guidelines 4.106; Motor Accident Injuries Act 2017 s 6.19. Checked September 2026.
5. What a declined request has to tell you
A refusal is not allowed to be a sentence in an email. Where an insurer declines a treatment request, clause 4.106(b) requires it to give you the reasons for the decision, a list of all the information relevant to that decision including material that does not support it, copies of that material, your internal review rights, and contact details for the Independent Review Office. That obligation is genuinely useful, because the list of material is where you find out what the insurer actually relied on and whether your treating practitioner’s report was in front of the decision-maker at all.
One structural point about internal review is worth knowing before you start. Clause 23 of the Motor Accident Injuries Regulation 2017 provides that no costs are payable for legal services provided in connection with an application to the insurer for internal review, so a review of a treatment decision stands or falls on the clinical record rather than on advocacy.
Source: SIRA, Motor Accident Guidelines 4.106(b); SIRA, Legal costs in claims for CTP statutory benefits (updated 12 September 2025). Checked September 2026.
6. Why “they stopped paying for my physio” is a documentation problem first
Treatment disputes are the most common thing people argue with CTP insurers about, by a wide margin. From the start of the current scheme to 30 June 2025, 13,428 internal reviews concerned whether treatment and care was reasonable and necessary. Of those, 3,348 were decided in the injured person’s favour, which is about a quarter. SIRA reports that the most common type of decision reviewed relates to reasonable and necessary treatment and care.
Source: SIRA, 2017 CTP Scheme Performance Report to 30 June 2025, Table 8. Checked September 2026.
A quarter overturned tells you two things at once. The decisions are not arbitrary, or the overturn rate would be far higher. And a meaningful number of them were wrong on the evidence available at review, which usually means the evidence arrived late. Insurers are also entitled to send you to their own medical examiner, and clause 4.157 of the Guidelines treats such a request as ordinarily reasonable precisely when the treating practitioner has not responded to a request for information, or where the information they did provide was inadequate. Silence from your own clinician is what invites someone else’s opinion into your file.
7. What our clinicians actually do about this
Our doctors, physiotherapists and psychologists treat CTP patients every week, and the reporting is treated as part of the treatment rather than as paperwork that happens afterwards. In practice that means the initial assessment produces measurable baselines rather than adjectives, the treatment request is written against the five criteria in order, the requested block has a review point attached, and insurer correspondence is answered while the question is still live. Where a request is declined, we tell you before your next appointment and go back with what the reasons asked for.
Two commercial details matter to you as well. Doctors treating CTP patients are paid at the applicable Australian Medical Association rates rather than at a SIRA-set schedule, under Guidelines 4.101. SIRA sets no maximum fee for allied health in the CTP scheme at all, which means rates have to be agreed with the insurer before treatment starts. We do that agreeing before you are booked, not after. And an honest caveat: if an insurer denies liability or declines a request and you go ahead regardless, SIRA is clear that the accounts become your personal responsibility, so we confirm approval in writing before treating on it.
Source: SIRA, Motor Accident Guidelines 4.101; SIRA, Fees paid for motor crash health services (updated 18 September 2025). Checked September 2026.
8. How long the funding runs
Two horizons apply, and which one you are on is a clinical question. Where the injury is classed as threshold, or where you were wholly or mostly to blame for the crash, the Act draws a line at week 52: section 3.28 ends the funding of treatment and care there, and section 3.11 ends weekly payments at the same point. Outside both of those situations the funding of treatment has no calendar attached to it at all. It continues while the statutory test keeps being met, with weekly payments running to 104 weeks, and further again where a damages claim is on foot.
The definition of a threshold injury turns on things a clinician records or fails to record, and it is less clear-cut than a two-column table suggests. A complete or partial rupture of a tendon, ligament, meniscus or cartilage is excluded from the soft tissue definition outright. Nerve tissue is excluded too, but the Regulation then returns an injury to a spinal nerve root to the threshold category where it manifests in neurological signs other than radiculopathy, so a neurological sign on its own does not decide the question. Radiculopathy is the finding that carries weight. Those are examination and imaging findings, made in the early weeks, and the insurer’s decision about benefits after the first 52 weeks does not fall due until nine months in under section 6.19(2). Evidence has to exist before it can be weighed. If your injury is a neck injury, our whiplash treatment page covers what that classification means in practice.
Source: Motor Accident Injuries Act 2017 ss 1.6, 3.11, 3.12, 3.28 and 6.19; SIRA, Providing allied health services in the NSW CTP schemes — FAQs. Checked September 2026.