Certificate of Capacity and your pre approved physio sessions

What a Certificate of Capacity actually is

A Certificate of Capacity, also called a Certificate of Fitness, is the medical certificate completed by your nominated treating doctor in the NSW workers compensation system. It sets out the nature of your injury, your current capacity for work, and the treatment you need for a safe and durable recovery.

It is the main way your doctor communicates with the insurer. It helps the insurer make decisions about your treatment and entitlements, and it guides your injury management plan and your return to suitable work.

We work alongside your treating doctor so our physiotherapy supports the plan set out in your certificate. We are not the ones who issue it; your doctor does that, and we keep our treatment lined up with what it says.

The same certificate is used for both workers compensation and CTP motor accident claims, so this applies whether you were hurt at work or on the road.

How to start with us, and why there is no gap to pay

Starting is simple. Bring your claim number and a copy of your Certificate of Capacity, and let us know your insurer or scheme agent (for example icare NSW, EML, Allianz, Gallagher Bassett, QBE or DXC). You can call us on (02) 8330 6776, email [email protected], or use Book online.

On an accepted claim, reasonably necessary treatment is billed directly to your insurer. That means 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 approved or reasonably necessary treatment only, not to claims that are still pending or have been declined. If you are not sure where your claim is up to, bring what you have and we will help you work it out.

• Your claim number
• A copy of your Certificate of Capacity
• Your insurer or scheme agent name and your case manager if you have one
• Any referral or imaging you have been given
• Comfortable clothing you can move in

Your first sessions can be pre approved

If you have an accepted NSW workers compensation claim, we can usually start your physiotherapy without waiting for further approval. Where your injury has not been treated by a physiotherapist, chiropractor, osteopath or accredited exercise physiologist before, and treatment begins within three months of your injury, SIRA allows up to eight physiotherapy consultations before any further approval is needed. This applies 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, and a practitioner returning to an injury treated more than three months ago has one. Treatment must always be reasonably necessary.

Every claim is a little different, and individual insurers and case managers manage the claim, so we confirm your exact arrangement with your insurer or case manager before we begin. We will never overstate what you are entitled to.

What we do during those sessions

Your first visit is a 60 minute assessment. We take a full history, examine the injured area, and build a clear picture of your current capacity for work and day to day life. From there we agree a plan with you that lines up with your Certificate of Capacity and your injury management plan.

Treatment is hands on and evidence based. Depending on your injury that can include joint mobilisation, soft tissue release, dry needling and a graded exercise rehabilitation program you can keep doing between visits. Follow up visits are 40 minutes.

Where it helps your recovery and your return to work, we communicate with your treating doctor, your case manager and your employer so everyone is working to the same plan.

What happens after your pre approved sessions

If you need treatment beyond the initial pre approved sessions, we submit an Allied Health Treatment Request, or AHTR, to your insurer. This is the SIRA form physiotherapists use to ask for approval of further treatment.

The request 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; we cannot approve it ourselves. Once it is approved, treatment continues with no cost to you.

We handle this paperwork for you so there is no gap in your care. You can read more about how the scheme works on our workers compensation physiotherapy page, or learn about icare and WorkCover billing directly.

Telehealth if you cannot get to Miranda

If you live outside the Sutherland Shire or cannot easily travel, telehealth physiotherapy may be an option through PACT Virtual Care. Under workers compensation it is more restricted than a private session.

Per SIRA, telehealth must generally be provided in combination with in person services, unless your insurer has pre approved treatment delivered exclusively by telehealth. It must be by videoconference where available, and it must be consented to by you, the practitioner and the insurer.

We assess whether telehealth is clinically appropriate for you, case by case, and arrange any insurer approval that is needed before we begin.