Allied Health Treatment Request

For general information on how to view and download  PDF files, search online or look at:

• Download a file – Google Chrome Help
• Download files from the web – Microsoft Support
• Save, view, and search PDFs – Adobe Help Centre

These explanatory notes:

• provide guidance for allied health practitioners who deliver services in the NSW workers compensation and motor accident schemes (personal injury schemes) on completing the Allied health treatment request (AHTR)
• explain the purpose and requirements of each section of the AHTR.

How do I fill in the request?

You are expected to complete an AHTR in partnership with the person with a claim by developing recovery goals together.
You remain responsible for:

• completing an AHTR and submitting it to the insurer managing a person’s claim
• making sure the information provided on an AHTR is accurate.

If you intend on sharing personal information that is not directly related to the compensable injury or illness, make sure you obtain informed consent.

Date services first commenced

Document the date services were initially delivered by your practice (whether by you or another allied health practitioner working in the same practice) to a person with a claim.

Total number of consultations to date

Document the total number of consultations delivered by your practice (whether by you or another allied health practitioner working in the same practice) to a person with a claim.

Section 1: Injured person details

Document the details of the injured person, including their occupation before the injury occurred, claim number and the date that the injury or accident occurred.

Section 2: Your clinical assessment

Compensable injury or illness

Document your diagnosis of the compensable injury or illness based on your assessment of the person on the day you complete the form.
If diagnosis is not within your scope of practice, document the compensable injury or illness specified in the referral to you or on the Certificate of Capacity/Certificate of Fitness.

For example, carpal tunnel syndrome, adjustment disorder with depressed mood, anxiety, neck pain.
Where relevant, specify the anatomical site involved. If your working diagnosis differs from the certifying doctor’s diagnosis, contact the doctor to clarify the diagnosis and appropriate management.

Current clinical signs and symptoms

Document signs and symptoms of the compensable injury or illness. For example:

• Physical injuries may manifest as limited range of motion or reduced grip strength.
• Psychological injuries may be more contextual, such as reduced concentration in the afternoon, difficulties falling asleep most nights or withdrawal from usual social and recreational activities.

Risk screening

Identifying risk factors or conditions across the biological, psychological and social domains as early as possible during the assessment phase is essential because it informs and guides your treatment.

You should:

• Ask the person with a claim to complete a validated risk screening tool if they have not already completed one within four to six weeks of the initial consultation.
• Use a screening tool relevant to the person’s clinical presentation. You may also wish to use the flags model in the Clinical Framework.
• Document the name of the risk screening tool used, most recent date administered and the score.
• Share the results (with the person’s consent) with the insurer and other relevant scheme participants supporting the person’s recovery.

Pre-existing conditions

Document details of any pre-existing conditions identified during your assessment that may adversely impact the person’s recovery from the compensable injury or illness.

This may include relevant previous or current physiological injury(ies) or illness(es) and psychological injuries such as complex traumatic experience, emotional and mental health distress and personality vulnerabilities.

Capacity

Document information about the person’s capacity to perform certain activities relative to the injury(ies) or illness(es). Include their occupation if employed at the time the injury(ies) or illness(es) occurred. Under ‘Pre-injury capacity’, describe what the person could do prior to sustaining the injury or illness. Under ‘Current capacity’, describe what the person can do now (on the day of your most recent assessment).

Examples are provided in Table 2 and Table 3.

Table 2: Physical example – neck injury

Table 3: Psychological example – depression

Standardised outcome measures

Standardised outcome measures (SOMs) are tools that assess a person’s current and future health status. You can also use them to demonstrate effectiveness of treatment and justify treatment requests.

Choose at least one outcome measure that is reliable, valid, sensitive to change and relates to the:

• person’s injury, for example, the Neck Disability Index or the Depression Anxiety and Stress Scale
• functional goals of your treatment
• functional demands of the person’s work and/or usual activities before the injury(ies) or illness(es).

Note: Documenting range of motion alone is not a SOM.

The AHTR has three columns to record SOM scores:

• Initial score – record the date and score of the first SOM completed.
• Previous score – record the date and score of the SOM on the previous AHTR. If this is the first AHTR submitted for a person, write ‘N/A’ (not applicable) in this column.
• Current score – record the date and score of the latest SOM completed.

Interpretation of score(s)

Document a brief explanation of the score(s) to help the insurer understand what the scores mean for the person’s progress toward treatment goals and return to work or usual activity.

SIRA does not mandate the use of any particular SOM. Use your clinical judgement when selecting a SOM appropriate to a person’s clinical presentation.

When using the Consultation C item code, SIRA approved allied health practitioners are expected to use two or more SOMs or evidence-based risk screening tools relevant to the person’s clinical presentation. This clinically justifies why higher intensity or an increased level of specialty treatment is required.

The use of SOMs is a critical component of value-based health care and helps the person with a claim and the allied health practitioner monitor progress towards recovery together.

A range of SOMs are available on our website:

• Standardised outcome measures
• Acute whiplash

Section 3: Barriers to recovery and strategies to address

Barriers to recovery

Use the information from your assessment and risk screening to identify potential barriers to recovery. This may be done using the flags model in the Clinical Framework or via comprehensive history taking.

Barriers may include physical, psychological, social and/or other factors or conditions such as:

• non-compliance with self-management or treatment
• current medication regime
• lack of support at work
• social isolation
• negative impact of concurrent non-compensable health concerns
• distress with claims dispute process.

Strategies

Apply appropriate strategies to address issues and/or barriers identified. This may include:

• Tailoring your treatment approach to address the barriers. You can do this by talking to the person with a claim, treating doctor or other health providers in the treating team.
• Recommending ways the insurer can assist. You can do this by recommending a referral to other services such as a workplace rehabilitation provider.

Would you like any of the following assistance?

You can request the insurer to:

• contact you to discuss issues relevant to the person’s recovery or to request further assistance such as referring the person to a workplace rehabilitation provider
• arrange a case conference with some or all members of the support team (the person, insurer, nominated treating doctor, employer, workplace rehabilitation provider and other treating providers) to discuss treatment or any barriers that are limiting recovery
• arrange a referral to an independent consultant to seek guidance on how to overcome barriers and progress the person’s recovery.

For workers compensation scheme:

• A list of independent consultants is available on the our website.

For motor accident scheme:

• Insurers may refer you to an independent consultant listed on the our website or another expert.

Section 4: Treatment plan

Have previous goals been achieved?

Select if the goals on the previous AHTR (if applicable) have been achieved.

If the goals have not been fully achieved, document the reason(s) for this in Section 3: Barriers to recovery to help the insurer understand why there are delays to recovery.

Injured person goals

You are expected to develop recovery goals in partnership with the person with a claim.

To achieve this, you should:

• Undertake early and collaborative goal setting with the person to ensure you are focused on common objectives to achieve recovery. Collaborative goal setting also empowers the person to manage their own recovery.
• Focus on measurable improvements in function and participation at work, home and in the community. If the person was working at the time they sustained the injury, document a work goal.
• Make the goals specific, measurable, achievable, relevant and timed (SMART). Estimate timeframes for the person to achieve their goals. For example:
  • To return to my usual job as a retail assistant by 4 August.
  • To drive for an hour to my parent’s home by 6 July.
  • To return to training my child’s soccer team by 3 October.
  • To hang a load of washing on the line by 5 February.
  • To improve my concentration by reading the newspaper for 20 minutes per day by 12 April.
  • To meet up with friends once a fortnight for coffee by 3 March.

Injured person’s self-management

Empowering the person to self-manage their injury is a key treatment strategy and essential to recovery.

You should:

• Encourage the injured person to use strategies to control their symptoms and learn to function despite their symptoms. For example, perform a home exercise program, activity scheduling, pacing, establishing a sleep routine and healthy down-regulation strategies.
• Increase active strategies that support self-management as recovery progresses and decrease passive strategies.

Your intervention

Your intervention (treatment) should be based on the best available research evidence and the goals you develop in partnership with the person. Therefore, you are expected to document:

• the treatment you intend to use to achieve the person’s work, activity or participation goals
• the rationale for each treatment requested to help the insurer managing a person’s claim make a decision about approving or declining the treatment
• the number of additional sessions anticipated before discharge
• the anticipated discharge date.

Section 5: Services requested

The services requested should reflect the treatment documented in Section 4: Your intervention. Therefore, you are expected to document:

• the type of service
• the number of consultations or additional sessions anticipated (this is tailored to the person’s needs)
• the frequency or timeframes to deliver the requested services
• how the requested services will be delivered (in person or telehealth).

Submit an AHTR to the insurer managing a person’s claim with ample time before the requested treatment is proposed to commence. This provides the insurer sufficient time to review and decide to approve or decline the request.

Section 6: Your details

Before submitting an AHTR to the insurer managing a person’s claim, make sure you:

• Provide your Australian Health Practitioner Registration Agency (Ahpra) number (for all health professions registered under Ahpra) or peak association membership number (if your health profession is not registered under Ahpra).
• Provide your SIRA approval number (if you are a SIRA approved physiotherapist, chiropractor, osteopath, psychologist, counsellor or accredited exercise physiologist delivering services in the NSW workers compensation scheme).
• Provide an individual email address and practice email address where you propose to deliver services.
• Sign the form (must be the allied health practitioner who completed the AHTR in partnership with the person with a claim and will be delivering the services outlined in the AHTR). You create your digital signature by selecting the signature box on the AHTR.

Section 7: Insurer decision

Insurers will use the information you provide in the AHTR to approve or decline treatment. They may seek advice from their clinical advisor or an independent consultant as part of the treatment approval process.

Insurers may also refer the treatment request to an independent consultant.

The insurer managing a person’s claim will:

• send their decision to approve or decline treatment in writing to the person with a claim
• outline any reasons for declining services or approving some services only.

The insurer managing a person’s claim may also request more information from you to assist their decision making. Even when they request more information from you, they are expected to make a decision within the timeframes set out in the laws underpinning both schemes.

For the workers compensation scheme:

• A decision must be made within 21 days after receiving a treatment request.
• A decision must be made within 5 working days after receiving a treatment request, otherwise it is automatically approved, in the following circumstance:
  • a SIRA approved allied health practitioner requests treatment within 3 months of the injury or illness (physical or psychological) and
  • the injury or illness (physical or psychological) has not been treated previously by an allied health practitioner from the same health professional group as the requesting allied health practitioner.

For the motor accident scheme:

• A decision must be made within 10 days after receiving a treatment request.

SIRA monitors the timeframes in which insurers make their decision to approve or decline treatment. SIRA takes regulatory action on insurers who do not meet their legal obligations in responding to treatment requests in a timely manner.