Regulatory
The SIRA workers compensation medical guide defines what a nominated treating doctor must do, from certificates of capacity to reasonably necessary treatment. It sets the benchmark for good medical management on a claim.
What the workers compensation medical guide covers
The guide explains the medical practitioner's role in the NSW workers compensation system, the other members of the worker's support team, payment and invoicing, and common questions. It is grounded in the same evidence base as the rest of the scheme: good work supports recovery, and most workers who take time off recover at work within the first 13 weeks. It has also been updated to reflect the Guidelines for the Provision of Relevant Services.
The nominated treating doctor's role
Beyond assessing, diagnosing and treating, the nominated treating doctor has two scheme-specific responsibilities: to support the worker to return to and recover at work through appropriate clinical intervention, and to contribute to recovery planning with the rest of the support team. The guide repeatedly pushes the focus toward what the worker can do rather than what they cannot.
Reasonably necessary treatment
The insurer must decide, on the facts of each case, that a treatment is reasonably necessary and required as a result of the injury before approving or paying for it. The guide tells doctors that treatment must be evidence-based, directly related to the injury, and recorded on the certificate of capacity, and that the insurer will not pay for treatment that is experimental, not reasonably necessary, or not delivering objective improvement.
Prescribing rules
The prescribing section is where the guide is most concrete. Doctors must prescribe through the PBS where clinically appropriate and available. A private prescription is only appropriate in limited circumstances, for example where the medication is not on the PBS or the worker does not meet the PBS criteria.
The certificate of capacity
The certificate is the primary communication tool. It must include a clear diagnosis, treatment plan and any factors affecting recovery, and it should not cover more than 28 days unless clinical reasoning supports longer. Where the worker has capacity, the doctor must complete the hours, days and capacity detail so the employer can identify suitable duties.
Why injury managers should read it
The medical guide is effectively the standard against which medical management on a claim can be measured. It tells injury managers what a well-completed certificate looks like, when a high-risk medication should come with a written rationale, and when a referral to a workplace rehabilitation provider or independent input is warranted. That makes it a useful reference when a claim's medical picture is unclear or a script is escalating.
Key Takeaways
- The medical guide defines the nominated treating doctor's role and their recovery at work responsibilities.
- Treatment must be reasonably necessary, evidence-based and recorded on the certificate of capacity.
- Doctors must prescribe through the PBS where clinically appropriate and available.
- High-risk private prescriptions require a written clinical rationale to the insurer.
- The certificate of capacity should not cover more than 28 days without clinical reasoning.
Frequently Asked Questions
What is the nominated treating doctor's role?
The nominated treating doctor assesses, diagnoses and treats the worker, and also supports their recovery at work through the certificate of capacity and collaboration with the support team. Their primary objective is to help the worker optimise recovery, focusing on what the worker can do.
What are the prescribing rules under the medical guide?
Doctors must prescribe through the PBS where clinically appropriate and available. If they privately prescribe a high-risk medication such as opioids, benzodiazepines, Z-drugs or medicinal cannabis, they must give the insurer a written clinical rationale explaining why.
How long should a certificate of capacity cover?
A certificate of capacity should not cover a period of more than 28 days, unless clinical reasoning supports a longer timeframe, such as a serious injury or planned surgery with a known prolonged recovery. It must state a clear diagnosis, treatment plan and capacity for work.
Primary source: State Insurance Regulatory Authority (SIRA), Workers compensation guide for medical practitioners, updated 2025.
