CTP Referrals

• NSW CTP scheme


  Legislated by the Motor Accident Injuries Act 2017 (MAIA) and Motor Accident Injuries Regulation 2017 (the Regulation), and the Motor Accidents Compensation Act 1999 (MACA)
• Exceptions to the NSW CTP scheme

  • Those injured in a vehicle accident in the course of their employment (workers compensation system instead)
• Referral Process


  1. Similar to the Worker's Compensation Scheme, a referral is required to see an AEP, issued either by the NTD or the rehab provider

  2. Prior approval should be obtained by the AEP from the insurance company (ensures all services will be paid for) - important details include claim number, DOI, and personal info

  3. Once approval is received, the AEP should complete an initial assessment and submit a report detailing the clinical findings and future treatment plan

  4. Then, the AEP should complete an AHRR and thesis to send to the insurance company to request more treatment sessions
• Exceptions when requesting treatment

  • When pre-approval is given, make sure to check that the client has a valid CTP claim no. - only initial consultation can be conducted, further consultation requires an AHRR to be completed
  • If a response is not received within 10 working days, contact the CTP insurer to ensure you have approval, otherwise it can be assumed to be approved
• Role of an AEP

  To assist the injured client in functional upgrades, through evidence based clinical intervention and management
• Criteria for 'reasonable and necessary' treatment

  • Directly related to the injuries sustained in the motor accident
  • Aimed at helping the injured person get back to their usual activities
  • Appropriate for the type of injury
  • Provided by an appropriately qualified health professional
  • Cost effective
• Invoicing


  All invoices should be sent accounts directly to the CTP insurer. Issue the account in the form of a tax invoice and include: the appropriate service code, the injured person's name, date of accident, the insurer's reference/claim number, the provider's ABN, address and GST (if applicable)
• The NSW Motor Accidents Scheme has 10 days from receipt from the AHRR to approve or deny such services. If the allied health practitioner does not hear from the insurer in this time, all treatment requested is automatically approved
• Treatment that is NOT included as "reasonable & necessary treatment" is "treatment that is appropriate for improving the general fitness/well-being of the injured person"
• Pre-approval is given for 1 AEP conducted initial consultation to patients with a valid CTP claim number. Any further sessions require completion of an AHRR