Physiotherapy services guidelines

The provision of physiotherapy services

These guidelines are in line with the Workplace Injury Rehabilitation and Compensation Act 2013 (WIRC Act) and the Accident Compensation Act 1985.

WorkSafe will have regard to these guidelines when making decisions for the provision of physiotherapy services to people who have an accepted claim under the Victorian Workers Compensation Scheme.

Throughout these guidelines, any reference to WorkSafe also includes WorkSafe’s agents and self-insurers.

Physiotherapy services

WorkSafe can fund physiotherapy services to assist people to effectively recover from workplace injuries and safely return to work and life.

Physiotherapists are qualified allied health professionals whose focus is on the structure and movement of the human body. They work with people to improve physical mobility and movement related to general musculoskeletal conditions and neurological and respiratory conditions. They work across the spectrum from health prevention to acute and rehabilitation care.

Physiotherapists can provide services, together with other health professionals, to plan and manage treatment. A treatment plan will consider a person’s lifestyle, activities and general health.

What we can pay for

WorkSafe can pay the reasonable costs of physiotherapy services a person needs as a result of a work-related injury or illness under Victorian workers compensation legislation.

The treatment or service must meet the following criteria.

• Be clinically justified, safe and effective.
• Be likely to achieve measurable improvement in a person’s functioning.
• Promote progress toward a person’s functional independence, participation and self-management.
• Be for rehabilitation purposes for a work-related injury only.
• Be delivered in line with the Clinical Framework.

WorkSafe will periodically review a worker's entitlement to physiotherapy services to ensure the treatment and services remain reasonable for the work-related injury and/or illness and are payable under the legislation.

Services we will not pay for

Under the workers compensation legislation, WorkSafe cannot pay for the following physiotherapy services.

• Services that are not required as a result of a worker’s accepted injury or illness.
• Services for a person other than the person with an accepted claim.
• Services that are not a reasonable cost as determined in accordance with the workers compensation legislation.
• Services provided outside of Australia without prior approval from WorkSafe or the employer.
• Services provided by a person in the relevant profession who, under the Health Practitioner Regulation National Law either:
  • is not registered
  • is registered as a student, or
  • holds limited or non-practising registration.

Under WorkSafe’s determination of reasonable cost, WorkSafe will not pay for costs relating to the following.

• Treatment and services that do not align with the Clinical Framework.
• Items that are not billed in line with the physiotherapy fee schedule.
• The provision of multiple disciplines or concurrent physical treatments or consultations (for example early intervention physiotherapy, chiropractic, osteopathy, exercise physiotherapy or acupuncture) with exceptions such as group exercise or group aquatic physiotherapy.
• Where two or more people are booked and/or treated at the same time, WorkSafe will not pay for individual consultations. Payment will be made at the applicable group consultation rate.
• Consultations provided more than once on the same day to the same worker in relation to a single claim number.
• A single service or consultation billed to more than one claim held by the worker. If a single service or consultation is treating injuries under multiple claim numbers, it should be billed to the most active claim only.
• Non-attendance or cancellation of appointments.
• Multiple claims for travel to and from the practice for community consultations provided consecutively.
• Services provided to a worker without the worker requesting an appointment.
• Services provided by telephone or other non-face to face platform not in line with WorkSafe’s Telehealth policy.
• Telephone calls and telephone consultations between providers and workers, and between other providers, including hospitals, that do not align with WorkSafe's Telehealth policy.
• Consumable items used in the course of the consultation.
• Pharmacy items such as creams and gels supplied by health professionals.

Subsequent certificates of capacity

A physiotherapist can issue a subsequent certificate of capacity if the worker's capacity for work is affected by a work-related injury.

Only a medical practitioner can issue the first certificate of capacity.

Each certificate of capacity is valid for a maximum of 28 days. A certificate of capacity for a period longer than 28 days cannot be issued unless special reasons exist and a longer timeframe is approved by WorkSafe. No further certificate of capacity should be issued within 28 days from the date of the last certificate of capacity, unless there is a change in the worker’s capacity. A “change in capacity” means a change in the functional tolerances and/or capabilities of the worker which will influence the hours or duties they are able to perform at work.

Subsequent certificates of capacity:

• must be signed by the worker and a copy retained in the worker’s clinical records
• are not required if the worker is not receiving or seeking weekly payments
• are not payable under the physiotherapy services guidelines
• must not be provided to workers by telehealth unless there are exceptional circumstances and prior approval is sought from WorkSafe. The telehealth consultation should be audiovisual not audio only.

How much we can pay

WorkSafe will pay for physiotherapy services in line with the Physiotherapy fee schedule.

In some cases, there may be a gap between what the provider charges and what WorkSafe can pay as the reasonable cost. If the provider charges more than what WorkSafe will pay, workers must pay the difference. In this instance, WorkSafe recommends the provider advise the worker before providing any services.

Physiotherapists must comply with WorkSafe’s instructions for invoicing.

Who can provide these services

WorkSafe will only fund physiotherapy services delivered by providers that meet the following conditions.

• Are registered with the Physiotherapy Board of Australia in conjunction with the Australian Health Practitioner Regulation Agency (AHPRA). Services from providers with student, limited or non-practising registration will not be funded.
• Hold the requisite insurance coverage to deliver physiotherapy services.

Find out how to register as a WorkSafe provider.

Accessing services

Where there is an accepted WorkSafe claim, workers can access physiotherapy services for a work-related injury or illness without prior approval from WorkSafe or a referral from a medical practitioner.

WorkSafe does not require any information from a physiotherapist before commencement of initial treatment for a work-related injury.

However, once treatment has commenced, the physiotherapist must complete a WorkSafe Allied Health Recovery Management Plan (AHRMP), including baseline measures and a psychosocial risk screening questionnaire.

Allied Health Recovery Management Plan

An initial AHRMP must be completed and submitted to WorkSafe advising that treatment has commenced. This provides information regarding the goals, strategies, proposed outcomes and timelines of treatment.

The initial AHRMP must be submitted within the first 5 consultations.

• If the worker has previously attended a different physiotherapy clinic, an initial AHRMP is expected from the new clinic within the first 5 consultations.
• The initial consultation fee includes the time taken to complete the initial AHRMP for submission to WorkSafe.
• A copy of the initial AHRMP must be retained in the worker’s clinical records.
• For workers that are part of the Community Integration Program, the request, approval and submission of outcome measures for services will form part of the independence planning process.

WorkSafe may request a subsequent AHRMP as part of a treatment review. A worker’s employer may also request a copy of an AHRMP.

Subsequent AHRMPs must include updated outcome measures and treatment goals. Standardised outcome measures are preferred as they are reliable, valid and sensitive to change. Consistent use of relevant standardised outcome measures helps track progress over time and determine whether the worker’s condition is improving, worsening, or remaining unchanged.

12-month treatment review

WorkSafe regularly reviews allied health services provided to workers. These reviews ensure treatment is clinically justified, aligned with the principles of the Clinical Framework, and supports the worker’s recovery and return to work.

The review process:

• For workers still receiving physiotherapy services at 9 months from their date of injury, the physiotherapist must submit an up-to-date AHRMP to WorkSafe if the worker is expected to require physiotherapy services beyond 12 months from their date of injury.
• The time taken to prepare the AHRMP submitted for the 12-month treatment review can be reimbursed as a one-time payment in accordance with the EIPF services fee schedule.
• Once submitted, the physiotherapist can continue to provide treatment, as outlined in the AHRMP, until WorkSafe advises that a decision has been made about the worker’s entitlement to physiotherapy services.
• WorkSafe will advise the outcome of the 12-month treatment review in writing. The treating physiotherapist and the worker will both receive a copy.
• If further physiotherapy services are required beyond the approved AHRMP end date, the physiotherapist must submit a new AHRMP before the end date or before the number of approved services have been delivered to request approval for further services. The time taken to prepare this further AHRMP cannot be reimbursed.

Physiotherapists are not required to submit AHRMPs for workers who are already more than 12 months from their date of injury unless WorkSafe requests updated information.

WorkSafe may request an AHRMP or other clinical information in writing at any time. The physiotherapist must provide the requested information within 14 days. If requested information is not received, WorkSafe may be unable to determine whether ongoing services remain reasonable and necessary. As a result, WorkSafe may be unable to approve or continue payment for physiotherapy services until the requested information is received.

Clinical Support Service

WorkSafe recognises that treating people with a work-related injury or illness often comes with challenges for providers.

The Clinical Support Service provides direct access to WorkSafe’s Clinical Panel experts, a group of highly experienced and qualified allied health and medical professionals. The service provides free support and advice for medical and health service providers related to the treatment of workers with an accepted claim.

Get in touch with the Clinical Panel for support with:

• completing certificates of capacity, Allied Health Recovery Management Plans, treater questionnaires, treatment plans and reporting
• applying the principles of the Clinical Framework and using outcome measures
• managing complex treatment and recovery barriers, and addressing concerns you may have
• preparing for, and having difficult conversations with workers
• brainstorming discussions around treatment pathways and available support when progress starts to plateau.

Service delivery expectations

WorkSafe expects that all providers delivering physiotherapy services as part of the Victorian workers compensation scheme follow the below principles.

• Provide culturally safe and respectful services.
• Protect the person’s human rights and report any concerns of abuse, neglect or discrimination to an appropriate regulatory or complaints body.
• Support the person to maximise their independence, and promote recovery and self-advocacy. WorkSafe also expects that any treatment provided is reasonable, clinically justified, outcome focused, and in line with the Clinical Framework.

Clinical Framework for the delivery of health services

WorkSafe, in consultation with peak bodies including the Australian Physiotherapy Association, has developed the Clinical Framework to set out key principles for the delivery of services to workers.

All healthcare professionals providing services to people with an accepted claim for a work related injury are expected to adopt the following principles.

• Measure and demonstrate the effectiveness of treatment.
• Adopt a biopsychosocial approach.
• Empower the injured person to manage their injury.
• Implement goals focused on optimising function, participation and return to work.
• Base treatment on the best available research evidence.

WorkSafe expects that all health professionals providing services to workers integrate the principles of the Clinical Framework into their daily practice.

WorkSafe has reporting and engagement expectations for all providers delivering physiotherapy services to workers. WorkSafe expects providers to communicate, collaborate and provide information to WorkSafe and other relevant parties as required.

For example, providers should work with treating health practitioners or other providers to enable the most appropriate treatment. Providers should also work with occupational rehabilitation providers, treating health practitioners and employers in relation to return to work.

Provider conduct

It is expected that providers will comply with relevant professional codes and guidelines including the Code of Conduct required by AHPRA, and avoid potential conflicts of interest. Providing services to family members, friends or colleagues should be avoided unless exceptional circumstances exist. For example, in an emergency situation, or where there are access issues due to rurality.

Providers must not submit invoices for services not directly related to a person’s work-related injury or illness. Under the worker’s compensation legislation, it is an offence to obtain or attempt to obtain fraudulently any payment or to provide false or misleading information.

Physiotherapy providers are required to comply with the requirements set out in these guidelines and in the application for registration to provide services to workers.

If a provider does not meet these requirements, or WorkSafe has concerns about the provider’s conduct or services delivered, WorkSafe may take appropriate action in accordance with the workers compensation legislation.