The State Insurance Regulatory Authority (SIRA) has identified almost $175 million in delayed payments across New South Wales personal injury schemes and has begun a targeted program aimed at reducing the risks these delays pose to the operation and performance of the schemes.
In response to the delayed payment findings, SIRA has begun an education program directed at health and related service providers, reminding them of invoicing timeframes and the effects of delays on claims management and scheme operation. Under Part 6 of the Guidelines for the Provision of Relevant Services (Health and related services), providers must lodge invoices with insurers within 30 days of delivering a service. Failure to meet this requirement can lead to slower payments, more frequent disputes, and financial leakage in the workers compensation and motor accidents schemes.
SIRA is using its Supervision Assurance Program to monitor compliance. The program applies a structured, risk‑based method to assess provider behaviour and identify practices that may affect scheme objectives, including the timing of benefits to injured people and cost outcomes for the schemes. Where risks are identified, SIRA has indicated it will work with health providers and insurers to address causes of delay and reinforce expectations around invoicing and payment practices. The stated focus is on recurring patterns of late billing rather than isolated cases.
SIRA’s responsibilities for health and related service providers are set out in the State Insurance and Care Governance Act 2015 and the State Insurance and Care Governance Regulation 2021, which define “relevant service providers” (RSPs) and outline the regulatory tools available to the authority. Relevant service providers include:
Under sections 26C and 26D of the act, SIRA can direct these providers to supply information, require specified actions, or limit specified services within the schemes. It can also keep a register of providers that receive directives and issue regulations and guidelines that govern service delivery and billing for workers compensation and compulsory third party (CTP) claims.
SIRA’s compliance activity focuses on adherence to the Guidelines for the Provision of Relevant Services and to the workers compensation and motor accidents legislation, regulations, and associated guidelines. Matters that may prompt regulatory attention include:
According to SIRA, it gives priority to patterns of non‑compliance over single events. When non‑compliance is identified, the regulator considers a range of factors before deciding on a response, and relevant service providers are given an opportunity to explain their conduct and outline why further intervention may not be needed. Complaints about clinical or professional standards generally fall outside SIRA’s direct jurisdiction. Where concerns arise about potential risks to an injured person’s health or welfare, SIRA may refer matters to other bodies, such as the Health Care Complaints Commission or the Health Professional Councils Authority, rather than engaging with individual treatment decisions.
In December 2025, SIRA outlined three projects intended to “help evolve how we regulate health providers, improve how medical practitioners work within the schemes and with people who have an injury.” The first is a Strategic Review of Health Provider Regulation in the NSW personal injury schemes. The review responds to SIRA’s regulatory priorities, which include targeting systemic non‑compliance and reinforcing supervision of relevant service providers whose practices influence scheme outcomes. Targeted consultation with insurers, provider groups, and other stakeholders is scheduled to start in January 2026, alongside a public consultation process through the NSW government’s Have Your Say platform. SIRA has said feedback from these processes will be used to consider possible changes to the regulatory framework for health and related providers.
SIRA is also reviewing the Certificate of Capacity/Certificate of Fitness used in workers compensation and CTP claims. The certificate is a document relied on by insurers and employers to understand an injured person’s work capacity and to plan duties and supports. The review is considering options to improve the quality and relevance of information provided to stakeholders, with the stated aim of supporting return‑to‑work planning and recovery outcomes. Any changes may alter how capacity information is collected, interpreted, and applied in claims decisions and rehabilitation planning.
The third initiative is a medical practitioner efficacy research project examining the role of medical practitioners, particularly general practitioners, in the recovery and return‑to‑work process for injured people within the NSW schemes. SIRA is in the process of selecting a research partner to carry out an action‑oriented study that will “clarify and enhance the efficacy of medical practitioners in the NSW personal injury schemes.” The project will look at the roles and challenges practitioners face in scheme contexts and is expected to produce recommendations to inform future SIRA policy. The research will explore how GPs and other medical practitioners interact with insurers, employers, and injured people; how certification, communication, and treatment decisions link with scheme processes; and where policy or practice changes could alter outcomes within the schemes.
SIRA’s focus on delayed invoicing may lead to closer examination of provider engagement, invoice processing, and dispute handling to ensure alignment with the 30‑day invoicing requirement and with the regulator’s supervision approach. Health and related service providers may also review their billing procedures, record‑keeping, and compliance frameworks against SIRA’s guidelines and regulatory powers, particularly ahead of possible changes arising from the strategic review, the certificate review, and the medical practitioner research program during 2026. SIRA has indicated that further information on the invoicing work and on all three projects will be released as consultation and research activities continue.
