SIRA Scheme Regulation
The State Insurance Regulatory Authority (SIRA) has begun a body of work that will reshape how health providers and medical practitioners interact with the NSW workers compensation and CTP schemes. Three connected projects, including a Strategic Review of Health Provider Regulation and a review of the Certificate of Capacity, are now underway. For any provider that delivers services into the NSW personal injury schemes, this is the regulatory change to watch in 2026.
What SIRA is reviewing
SIRA has outlined three related projects focused on health provider regulation and clinical practice in the workers compensation and CTP schemes. The Strategic Review of Health Provider Regulation is assessing whether current rules and supervisory settings for health and related service providers remain aligned with scheme objectives. Alongside it, SIRA is reviewing clinical practice in the schemes and, separately, the Certificate of Capacity and Certificate of Fitness. These projects sit under SIRA 2025-26 regulatory priorities and the longer term SIRA 2028 strategy.
The Certificate of Capacity in focus
The Certificate of Capacity, and its CTP equivalent the Certificate of Fitness, is a central document in claims handling. It records an injured person functional capacity, treatment needs and work restrictions, and it informs benefit and treatment decisions. A review of the certificate signals potential change to how clinical information is captured and communicated across the scheme, which has direct implications for treating practitioners, insurers and claims teams that rely on it.
Who SIRA is consulting and when
Targeted engagement with industry began 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 runs alongside this through the NSW Government Have Your Say platform. SIRA oversees insurance compensation schemes covering around 10 million people, so the reach of the review is wide.
What this means for health providers and insurers
The review may lead to adjustments in provider regulation, clinical documentation standards and claims practice. Providers should treat the consultation as an opportunity to shape settings that will govern their work for years. Insurers and intermediaries should anticipate possible changes to how providers are approved, supervised and held accountable, and to the documentation that underpins liability and treatment decisions. Organisations that prepare submissions early, grounded in real practice examples, will be better positioned than those that wait for the final settings.
Key Takeaways
- SIRA has launched a Strategic Review of Health Provider Regulation for the NSW personal injury schemes.
- The Certificate of Capacity and Certificate of Fitness are being reviewed.
- Targeted industry engagement began in January 2026, with public consultation via Have Your Say.
- The review sits under SIRA 2025-26 regulatory priorities and the SIRA 2028 strategy.
Frequently Asked Questions
What is the SIRA Strategic Review of Health Provider Regulation?
It is a review assessing whether current rules and supervisory settings for health providers in the NSW workers compensation and CTP schemes remain aligned with scheme objectives.
Why is the Certificate of Capacity being reviewed?
The certificate records an injured person functional capacity, treatment needs and work restrictions and informs benefit decisions. SIRA is reviewing whether it remains fit for purpose.
How can providers have input?
Through SIRA targeted industry engagement and the broader public consultation on the NSW Government Have Your Say platform.
Primary source: SIRA 2025-26 regulatory priorities and SIRA 2028 strategy.
