WorkCover physiotherapy in Miranda

Already have an accepted WorkCover claim?

If your claim has been accepted, we can usually begin your physiotherapy without waiting for further approval. Where your injury has not been treated by a physiotherapist before and treatment begins within three months of your injury, SIRA allows up to eight sessions before any further approval is needed. After that we send your insurer an Allied Health Treatment Request setting out your progress and proposed plan, and continue your care once it is approved.

Every claim is a little different, so we confirm your exact arrangement with your insurer or case manager before we begin. Bring your claim number and your nominated treating doctor details to your first visit and we will take it from there.

This page is a quick guide for workers. For the full picture of how we run a claim from first visit to return to work, see our main workers compensation page.

NSW icare and WorkCover Queensland

WorkCover is the everyday name people use for workers compensation. In New South Wales the scheme is run through icare and its agents EML, Allianz, Gallagher Bassett, QBE and DXC. We are experienced across all of them and work closely with case managers day to day. PACT Physio and Rehab is an approved provider under SIRA, the regulator for the NSW scheme.

We also treat WorkCover Queensland claims. The schemes work a little differently, so we check the rules that apply to your claim and bill the right insurer correctly, with no gap to you on an accepted claim.

If your injury came from a motor vehicle accident rather than work, that falls under CTP rather than WorkCover. We handle those claims too, billed directly to the CTP insurer.

What it costs you on an accepted claim

On an accepted workers compensation claim, reasonably necessary treatment is billed directly to your insurer. That means you have nothing to pay at the time of your appointment and no gap fee. We invoice the insurer on your behalf for all approved sessions.

No gap billing applies to accepted claims and to treatment that is approved or reasonably necessary. It does not apply while a claim is still pending or if a claim is declined. If your claim is not yet accepted, talk to us and we will explain your options, including paying privately in the meantime if you choose to start sooner.

For reference, our standard fees are $165 for an initial physiotherapy session of 60 minutes and $142 for a follow up of 40 minutes. On an accepted claim these are billed to the insurer, not to you.

Your pre approved sessions, and what happens after

Under the SIRA fees and practice requirements, where your injury has not previously been treated by a physiotherapist, chiropractor, osteopath or accredited exercise physiologist and treatment begins within three months of the injury, up to eight physiotherapy consultations can be provided without insurer pre approval. This applies to accepted claims and only when treatment is delivered by a SIRA approved practitioner.

The number is not the same in every situation. If treatment starts more than three months after the injury, up to three consultations may be provided without pre approval. If a practitioner is returning to an injury that was treated more than three months ago, one consultation applies. Because of this we always confirm the exact arrangement with your insurer or case manager for your individual claim.

If you need treatment beyond the initial pre approved sessions, we submit an Allied Health Treatment Request to your insurer. This is the SIRA form physiotherapists use to ask for approval of further treatment. It sets out your current presentation, your progress, any barriers to recovery and the proposed plan, including the number of further sessions and the expected timeframe. The insurer decides on the request, and once it is approved your care continues with no cost to you. We handle this paperwork for you so there is no gap in your treatment.

• Accepted claim, treatment started within three months, no prior physio, chiro, osteo or accredited EP treatment of that injury: up to eight sessions before further approval
• Treatment started more than three months after injury: up to three sessions without pre approval
• Returning to an injury treated more than three months ago: one session
• Beyond that: we submit an Allied Health Treatment Request and continue once your insurer approves it

Paperwork, reports and insurer communication

A claim runs on paperwork, and we take that off your plate. We provide same day clinical reports so your file keeps moving from day one, and we liaise with your case manager so you are not stuck chasing approvals between appointments.

We work alongside your nominated treating doctor so our treatment supports the plan set out in your Certificate of Capacity, the medical certificate that describes your injury, your current capacity for work and the treatment you need. It guides your injury management plan and your safe return to suitable work.

Where it helps, we coordinate with your employer on suitable duties and a staged return, matched to what your body can manage right now. The aim is a recovery that lasts, not just a quick clearance.

Can WorkCover physio be done by telehealth?

Telehealth physiotherapy can be available under workers compensation, but it is restricted. Under SIRA rules it generally needs to be provided in combination with in person services, unless your insurer has pre approved treatment delivered only by telehealth. It must be by videoconference where available, and it must be consented to by you, your physiotherapist and the insurer.

We assess whether telehealth is clinically appropriate for your injury case by case, and arrange any approval the insurer requires before we go ahead. If you are outside Sutherland Shire or cannot travel easily, ask us and we will look at what is possible for your claim.

Experienced in workers compensation and occupational rehabilitation

Your physiotherapist is Andrew Ellis, founder and principal at PACT. He holds a Bachelor of Science in Exercise Science, a Master of Physiotherapy, is completing an Executive MBA, and brings 16 years of experience across the SIRA NSW workers compensation scheme.

Drawing on his background as a Senior Rehabilitation Consultant and Workplace Health and Safety Advisor, and his experience providing injury management advice to insurers and employers, Andrew works closely with case managers and workplaces to support a safe and sustainable return to work. He is AHPRA registered and SIRA approved.

We are based at Unit 1/196 Sylvania Road, Miranda, open seven days, and we treat workers from right across Sutherland Shire.