The State Insurance Regulatory Authority (SIRA) has opened a public consultation on potential changes to the regulation of health providers in New South Wales personal injury schemes, a process that may affect workers’ compensation and compulsory third party (CTP) insurance from 2026. On Jan. 15, SIRA released a discussion paper to accompany an independent Strategic Review of Health Provider Regulation in the NSW personal injury schemes. The review is examining existing regulatory arrangements, identifying issues in provider conduct and oversight, and considering options to change how health providers operate within the schemes.
Stakeholders can lodge feedback through the NSW government’s Have Your Say website, either by completing an online survey or making a written submission. The consultation period runs from Jan. 15 to Feb. 20, 2026, and responses will be considered in the review’s findings and any subsequent recommendations. The consultation forms part of SIRA’s program to clarify expectations of health and related service providers whose decisions and documentation affect scheme costs, claimant experiences, and insurer processes in the workers’ compensation and CTP environments.
The Strategic Review is one of three projects SIRA has announced in the health provider space for 2026. In a December 2025 announcement, SIRA restated its overall mandate. “SIRA’s purpose is to ensure the 10 million people across NSW are protected under the state’s insurance compensation schemes by ensuring they have access to schemes that are fair and sustainable,” it said. Alongside the review of health provider regulation, SIRA is:
Targeted consultation with selected industry stakeholders on the Strategic Review began in January 2026, in parallel with the Have Your Say public process. SIRA has indicated that additional information and updates on the projects will be released as the work progresses.
The review of the Certificate of Capacity/Certificate of Fitness has potential implications for insurers, scheme agents, underwriters, and claims teams. SIRA is examining how the structure and completion of certificates influence the quality and consistency of information shared between treating practitioners, insurers, employers, and injured people. Areas under review include descriptions of functional capacity, work status, treatment planning, and prognosis, and how these elements support decision-making in claims. The authority is seeking opportunities to improve the information that underpins planning for recovery and return to work. Any resulting changes to certificate formats, guidance, or completion practices could affect claims intake, assessment, and ongoing management in both workers’ compensation and CTP portfolios, including how insurers interact with treating health providers and interpret medical evidence.
In parallel with the review work, SIRA is progressing a medical practitioner efficacy research project within the NSW personal injury schemes and is in the process of selecting a research partner. The chosen provider will conduct a study into the role of medical practitioners, with a particular focus on general practitioners who often act as the first point of contact for injured people. The project will look at how doctors contribute to recovery and return to work, the challenges they encounter under scheme rules and processes, and how clinical decisions intersect with insurance requirements and claims handling. The research is intended to produce recommendations to guide future policy and regulatory settings for health providers engaged in the schemes. For insurers and intermediaries, the findings may inform expectations around communication with treating practitioners, use of clinical information in decisions, and approaches to managing provider relationships.
These health provider initiatives sit within SIRA’s 2025–26 regulatory priorities, which focus regulatory attention on selected issues and align with the authority’s SIRA 2028 strategy. According to SIRA’s 2024–25 annual report, the authority’s regulatory work during the period was directed toward outcomes for injured workers, road users, and homeowners, while managing scheme performance and insurer conduct within its legislative remit. The report notes that SIRA applied a risk-based regulatory approach, expanded its use of digital channels, and adjusted customer-facing processes across workers’ compensation, CTP, and home building compensation schemes. More than 15,000 customer interactions were managed through its support systems, covering enquiries and complaints across the three schemes.
SIRA 2028 sets out five main goals to guide engagement with insurers, scheme agents, employers, builders, and other regulated parties:
For insurance professionals in Australia, the combination of consultation, review, and research indicates a period of policy development that may lead to operational changes from 2026 onwards. Possible areas of impact include:
As SIRA releases further material and, in time, any proposed changes, insurers, scheme agents, and brokers will be able to assess how provider regulation, clinical documentation requirements, and claims practices may need to adjust within the NSW personal injury framework.
