The State Insurance Regulatory Authority (SIRA) is preparing a series of changes that will affect how health providers and medical practitioners interact with New South Wales personal injury schemes from 2026, with potential implications for insurers, scheme agents, and employers.
SIRA’s role is to oversee insurance compensation schemes across NSW, covering about 10 million people. Within that role, the regulator has outlined three related projects focused on health provider regulation and clinical practice in the workers’ compensation and compulsory third party (CTP) schemes:
These projects fall under SIRA’s 2025-26 regulatory priorities and its SIRA 2028 strategy, which together set out how it plans to supervise schemes and regulated entities over the medium term.
The Strategic Review of Health Provider Regulation, now under way, will assess whether current rules and supervisory settings for health and related service providers are aligned with scheme objectives in the NSW personal injury system. The review stems from SIRA’s regulatory priorities, which commit the agency to “target systemic non-compliance” by strengthening oversight of service providers whose practices influence costs, outcomes, and participant experience in the schemes. It is expected to consider how provider behaviour affects return-to-work pathways, treatment patterns, and overall scheme performance.
Targeted engagement with key industry participants is scheduled to begin in January 2026. SIRA plans to consult insurers, scheme agents, medical and allied health providers, employer representatives, plaintiff and defendant legal firms, and consumer stakeholders. A broader public consultation is due to run alongside this via the NSW government’s Have Your Say platform. Further information on the review’s scope, timetable, and consultation materials is to be made available through SIRA’s website and regulatory communications, allowing insurers and intermediaries to provide feedback on potential changes.
In 2026, SIRA will also review the Certificate of Capacity/Certificate of Fitness used in the workers’ compensation and CTP schemes. The certificate is used in claims handling and benefit decisions to record an injured person’s functional capacity, treatment needs, and work restrictions.
The review will consider changes to the quality, clarity, and consistency of information shared between stakeholders through the certificate process. For insurers and employers, likely focus areas include:
Possible outcomes include updated certificate templates, revised guidance for treating practitioners, and adjusted expectations on how certificate data should be used in planning and managing recovery and work capacity.
A third initiative is a medical practitioner efficacy research project examining the role of doctors in recovery and return-to-work. SIRA is in the process of engaging a research partner to carry out what it describes as an “action-oriented study” of medical practitioner involvement in the NSW personal injury schemes. The study will explore how medical practitioners, particularly general practitioners, engage with scheme rules and stakeholders, and the practical issues they encounter in balancing clinical judgment, workplace considerations, and insurance requirements. The work is intended to produce recommendations to inform future policy and regulatory settings at SIRA.
For insurers and scheme agents, the findings may influence future models of engagement with GPs, expectations around certification practices, and communication between claim managers, employers, doctors, and injured people. SIRA has indicated that further information on the three projects will be released as consultation progresses and research milestones are reached.
The health provider initiatives form part of SIRA’s 2025-26 regulatory priorities, which support its purpose of ensuring NSW insurance schemes protect and support scheme participants over time. The priorities are intended to focus regulatory activity on selected areas and align with the organisation’s SIRA 2028 strategy.
In its 2024-25 annual report, SIRA outlines how its regulatory work has been directed toward outcomes for injured workers, road users, and homeowners, while managing scheme performance and insurer conduct within its statutory remit. During the reporting period, SIRA continued to apply a risk-based regulatory model, expanded use of digital channels, and concentrated on customer-facing processes for scheme participants. More than 15,000 customer interactions were managed through SIRA’s support systems, covering enquiries and complaints across the workers’ compensation, CTP, and Home Building Compensation (HBC) schemes.
Launched earlier this year, SIRA 2028 sets out five primary goals that will guide engagement with insurers, scheme agents, employers, builders, and other regulated entities:
For insurance professionals, the combined reviews and research point to a period of policy development that may lead to adjustments in provider regulation, clinical documentation, and claims practices from 2026.
