WorkCover Physiotherapy Direct Billing in Sydney
WorkCover direct billing means your physio invoices your employer’s workers compensation insurer, not you. On an accepted claim you don’t pay upfront, and you aren’t liable for the cost of treatment that’s reasonable and necessary. Here’s how it works in NSW, and what to have ready before your first session.
- No upfront cost on accepted claims
- SIRA-approved physiotherapists
- We deal with the insurer for you
How WorkCover direct billing works
The clinic sends each invoice straight to the insurer managing your claim. SIRA sets the maximum fees physios can charge, and the worker isn’t liable for the cost of reasonable and necessary treatment. Direct billing works when three things are in place:
- Your claim has been notified and the insurer has accepted provisional or full liability
- We have your claim number and insurer details before your first visit
- The treatment is covered, either within the sessions allowed without pre-approval or approved by the insurer
Key point: direct billing removes the upfront cost. It doesn’t replace the claim. Without a claim number we can’t bill the insurer, so call us first if your claim is still being set up.
The NSW rules: how many sessions are covered
Workers compensation in NSW is regulated by SIRA. Physiotherapists must be SIRA-approved to treat injured workers in the scheme. Once the insurer has accepted provisional or full liability, some physio can start without waiting for the insurer to approve it:
| Your situation | Physio sessions without insurer pre-approval |
|---|---|
| Treatment starts within 3 months of the injury | Up to 8 consultations |
| Treatment starts more than 3 months after the injury | Up to 3 consultations |
| Changing to a different physio for the same injury | 1 consultation |
| Further treatment after that | Your physio sends the insurer an Allied Health Recovery Request (AHRR) |
From 1 October 2026, treatment claims are assessed against a reasonable and necessary test: treatment has to be mainly for the work injury, clinically justified and cost-effective. A clear assessment and treatment plan is what shows that.
Getting started: step by step
Report the injury to your employer
Tell your employer as soon as you can, even if the injury seems minor.
See your GP
Your GP becomes your nominated treating doctor and issues a certificate of capacity describing the injury and what work you can do.
Make sure the claim is lodged
Your employer notifies the insurer. Once notified, the insurer has 7 days to start provisional payments unless it has a reasonable excuse. Ask for your claim number.
Book with a SIRA-approved physio
Give us your claim number, the insurer’s name and your case manager’s details when you book, so we can confirm direct billing before you arrive.
Start treatment
We assess you, set goals linked to your work capacity, and send an AHRR to the insurer if you’ll need more sessions than the early allowance.
If your claim is still being processed
Under provisional liability, the insurer can pay up to $10,000 in medical expenses for up to 12 weeks while it decides on the claim. If your employer hasn’t notified the insurer yet, there’s nothing for us to bill. Call us before booking and we’ll help you check where the claim is up to.
What to bring to your first appointment
- Your claim number and the insurer’s name
- Your case manager’s name and contact details
- Your current certificate of capacity
- Any scans, specialist letters or reports about the injury
Your first session covers a detailed history, a physical examination, how the injury affects your job, and a treatment plan. You should leave knowing what’s wrong, what the plan is, and what you can safely do at work in the meantime.
Talking to your employer and insurer
What we can share
With your consent, we can share your work capacity, restrictions and progress. That’s what your employer needs to plan suitable duties.
What stays private
Clinical details beyond what’s needed for your return to work aren’t shared unless you agree.
Case conferences
We can join calls with your GP, case manager or employer to agree on a return-to-work plan. SIRA’s fee schedule covers this, so you aren’t billed.
If your claim is declined or disputed
Read the decision notice
The insurer has to explain its reasons in writing and set out your next steps.
Ask the insurer to review it
Send any extra information that supports your claim, such as reports from your GP or physio. The insurer must respond in writing within 14 days.
Contact the Independent Review Office
If it isn’t resolved, the IRO (13 94 76) takes complaints about insurers and works to resolve them.
Apply to the Personal Injury Commission
The Commission resolves disputes about weekly payments, medical expenses and other entitlements.
WorkCover physio at Hopevana
We direct bill WorkCover and CTP claims with no upfront cost, and confirm your claim details before your first visit. Find WorkCover physio near you in Homebush, Pendle Hill and Strathfield, or read our full WorkCover physiotherapy guide.
Related reading: Work injury physiotherapy · Medicare care plan physio · Managing chronic pain long term
Frequently asked questions
Do I pay anything for WorkCover physio?
Not on an accepted claim. The physio bills your employer’s insurer directly, and workers aren’t liable for the cost of reasonable and necessary treatment. You’ll need a claim number before we can direct bill.
How many physio sessions are covered without approval?
Once the insurer has accepted provisional or full liability, up to 8 consultations can be provided without pre-approval if treatment starts within 3 months of the injury, or up to 3 if it starts later. After that, your physio sends the insurer an Allied Health Recovery Request for more.
What do I need to bring to my first WorkCover appointment?
Your claim number, the insurer’s name, your case manager’s contact details, your current certificate of capacity, and any scans or specialist reports about the injury.
Can I start physio before my claim is accepted?
Once your employer has notified the insurer, it can accept provisional liability and pay up to $10,000 in medical expenses while it investigates. Before the claim is notified there’s nothing to bill, so call us first and we’ll help you check the claim status.
What if my WorkCover claim is declined?
Ask the insurer to review the decision, adding any supporting reports. If that doesn’t resolve it, contact the Independent Review Office on 13 94 76, or apply to the Personal Injury Commission.
Injured at work? Bring your claim number and we’ll handle the billing.
Direct billing for WorkCover and CTP. Clinics in Homebush and Pendle Hill.
Sources: SIRA pre-approval of treatment · SIRA provisional liability · SIRA reform FAQs · SIRA declined claims. Last checked 12 October 2026. This is general information, not legal advice.
