NSW Workers’ Compensation Reform 2026: What Changed for Physiotherapy & Exercise Physiology Access

If you are on a NSW workers’ compensation claim and your physio has just told you they need to send a request to the insurer before your next appointment, nothing has gone wrong with your claim. The rules changed on 1 October 2026, and that request is now due sooner than it used to be.

Here is the change that matters most to you. Until the end of September, an injured worker starting physiotherapy could have up to eight consultations before the insurer had to approve anything. That allowance is now four. Almost everything else about your treatment, including the fact that you do not pay for it, works the way it did in September.

Most of what has been written about these reforms is pitched at insurers, lawyers and employers. This article is for the person waiting on an appointment. Every figure below    comes from SIRA’s own fee orders and guidelines rather than a summary of them, and each one is linked so you can check it.

What Is NSW Workers’ Compensation Reform 2026? (The Big Picture)

The reforms come out of two pieces of legislation: the Workers’ Compensation Legislation Amendment Act 2025 and the Workers’ Compensation Legislation Amendment (Reform and Modernisation) Act 2026. They have been switched on in stages across 2026 rather than all at once, which is most of the reason the information circulating is so muddled. A change that applies to psychological injury claims from July does not necessarily apply to your knee.

What Changed in NSW Workers’ Comp?

The table below separates the dates that affect your treatment from the ones that do not.

Sources: SIRA workers’ compensation reform FAQs; SIRA scheme changes commencing 1 October 2026.

One correction worth making, because it is repeated on a lot of pages: the treatment test did not change in July. July was mainly about psychological injury claims, impairment assessments and who may sit in on your appointments. The treatment test changed on 1 October. If you have been told otherwise, check the date against SIRA’s own reform FAQs.

The Reasonable and Necessary Test Explained (Plain Language)

The old wording was “reasonably necessary”. The new wording is “reasonable and necessary”. That looks like a quibble, but it is not. The reasonable and necessary test in NSW workers’ comp gives your insurer three questions to work through on every treatment claim made from 1 October 2026 onwards.

1. Is the main purpose of this treatment to treat the injury you have actually claimed for?
2. Is it clinically justified for that injury?
3. Are the costs reasonable, measured both against the benefit you get and against what alternative treatments would cost?

The first two questions are close to what insurers were already asking. The third is new, and it is the reason your physiotherapist’s request now has to say more than it once did. Cost-effectiveness is a comparison by definition, so your insurer is weighing your treatment against the alternatives available. That is why measurements have become the practical centre of this process. A request recording where your shoulder started and where it sits after four sessions gives the insurer something to weigh. A request saying “continuing treatment” gives them nothing, and an insurer with nothing to weigh is an insurer asking questions.

The regulation also names services an insurer can no longer pay for at all, whatever the circumstances. Massage is the one that catches people out, so take that one first: it is excluded unless a medical practitioner has prescribed it, and a prescribed massage still has to pass the three questions above. Reflexology, homeopathy, reiki, sound therapy, crystal therapy, wellness retreats and life coaching are out altogether. So are general health, fitness, social or recreational activities that no doctor has prescribed.

As for whether the test applies to you: it covers every worker, including exempt workers such as police, paramedics and firefighters, along with coal miners and volunteers. Dust disease claims sit outside it. There is one timing exception that matters a great deal, and the section on existing claims below deals with it properly.

Source: SIRA guidance on the reasonable and necessary reforms commencing 1 October 2026, which sets out clause 8P(2) and the exclusions in clause 8Q(1) of the Workers’ Compensation Regulation 2016.

Fee Changes Explained

Fees generate more worry than any other part of this reform and affect you less than any other part of it. The figures below are maximum fees for eligible services under SIRA’s fee orders. They are not bills issued to you, and you are not responsible for the covered treatment costs while the applicable protections apply.

Both the physiotherapy and the accredited exercise physiology fee orders took effect on 1 February 2026, and both carry the same rates for standard consultations.

Note: Standard initial and follow-up consultation fees are the same for physiotherapy and accredited exercise physiology under the relevant SIRA fee orders. The two-injured-area and complicated-hand-injury rates apply to physiotherapy only. The AHTR fee shown is for the initial request per claim, not every subsequent treatment request. GST is payable in addition to the listed fees.

Sources: SIRA physiotherapy, chiropractic and osteopathy fees and practice requirements (2025 and 2026); SIRA accredited exercise physiology fees and practice requirements (2025 and 2026). GST is payable in addition to these amounts.

So the increase runs at roughly four to five per cent on consultations. Group sessions did not move at all, and none of it reaches your pocket. Home visits sit on a separate scale, where a follow-up visit at home is funded at $117.20 rather than the $100.90 clinic rate. Travel is reimbursed at 88 cents a kilometre, but only where your insurer approved it beforehand.

Now the part that actually answers the question people are asking. Under both fee orders, a provider treating you on an accepted claim must not bill you directly, must not add a gap fee on top of what the insurer pays, and must not charge you for a cancelled or missed appointment. You are not liable for any cost the fee order covers.

There is a boundary on that protection, and you should know where it sits. It holds whilst your claim is accepted and your treatment is approved. If your insurer declines to fund further treatment, or your entitlement comes to an end, treatment you have after that point is yours to pay for. That is precisely the situation the drop from eight consultations to four makes a little more likely to arise, which is why the process below is worth five minutes of your time.

How Does Reform Affect Physiotherapy Access?

Is Physiotherapy Still Covered?

Yes. Physiotherapy appears nowhere on the excluded list, and nothing in the 2026 reforms removes it from the scheme. You also do not need a doctor’s referral to start, which turns out to be the single biggest practical difference between physiotherapy and exercise physiology under these rules. You can ring a physiotherapist yourself today.

Two things have to be true about the practitioner you choose. They need general registration with AHPRA, and they need to be approved by SIRA. Beyond that, the choice is yours, and SIRA’s guide for allied health practitioners says so directly: workers can choose their own treating practitioner, provided that practitioner meets the approval requirements. The NSW workers’ comp physiotherapy 2026 changes did not touch that right.

What’s the Physiotherapy Treatment Process Now?

The sequence has not changed. What has changed is how early in that sequence the paperwork lands.

1. The first 48 hours after your injury. Reasonably necessary treatment can go ahead with no insurer approval at all. Getting seen quickly costs you nothing in paperwork terms.
2. Your first appointment. The physiotherapist assesses you, and your starting measurements get recorded here. These carry more weight under the new test than they used to.
3. Consultations one to four. Where this injury has not previously been treated by a physiotherapist, chiropractor, osteopath or Accredited Exercise Physiologist, and treatment starts within three months of the injury, four consultations go ahead without pre-approval.
4. The Allied Health Treatment Request. Your physiotherapist submits an AHTR before those four run out. It sets out how the injury is affecting you, the goals, the treatment plan, the outcome measures being used, and how long recovery is expected to take.
5. The insurer decides. The insurer has 21 calendar days from the date they receive your request to decide on liability. If you do not get a response within five working days and your physiotherapist is still treating you for an injury that started within the last three months, you can have up to four more consultations under the same request.

Anything your insurer has already pre-approved sits outside the four-consultation cap entirely. The cap governs only what can happen before they have looked at a request.

What About Session Limits?

There is no cap on how much physiotherapy you can have on an accepted workers’ compensation claim. Keep that separate in your mind from the number that did change, because the two are being mixed up everywhere.

What changed is the pre-approval allowance. Until 30 September 2026, a physiotherapist could treat you for up to eight consultations before the insurer had to sign anything. From 1 October, Table 4.2 of the Workers Compensation Guidelines sets that figure at four. Past four, treatment continues on the strength of an approved request, and the guidelines write in no ceiling at all on how many requests or how many consultations an accepted claim can run through.

The practical effect is that your first treatment request now gets written at around session three instead of session seven. For a straightforward soft tissue injury that settles inside four sessions, you may never notice. For anything longer, the quality of that first request is carrying more weight than it did a month ago.

Three smaller allowances sit alongside the main one, and the October amendment left all of them where they were. Starting treatment more than three months after the injury, with no earlier treatment from that group of practitioners, allows three consultations without pre-approval. Going back to a practitioner who treated the same injury more than three months ago allows one, counted as a new episode of care. Seeing a different practitioner in a group that has already treated the injury also allows one.

Source: Table 4.2, Workers’ Compensation Guidelines, as in force from 1 October 2026.

If you have read the February 2026 fee orders yourself and seen the number eight, that is not a mistake on your part. Those documents predate the October amendment to the guidelines, and the guidelines are what now applies.

Not Sure Where Your Treatment Request Is Up To?

If your physiotherapist has mentioned sending a request to the insurer, or your sessions have paused whilst something is being approved, you have landed in the part of this process injured workers find most opaque. It is entirely reasonable not to know whether you are waiting on your provider, your insurer, or your nominated treating doctor.

Healthstin’s physiotherapists and Accredited Exercise Physiologists treat workers’ compensation claims across NSW, and preparing the Allied Health Treatment Request is part of how we work rather than something extra. A free 10-minute consultation is a low-commitment way to ask where things stand and what your claim allows before you book anything.

Call 1300 090 931 or book a free 10-minute consultation. You can also read how we work with workers’ compensation claims and what physiotherapy involves.

How Does Reform Affect Access to Exercise Physiology?

Is Exercise Physiology Covered Under the Reform?

Yes, and it has a fee order of its own, which is a useful signal in itself. SIRA sets maximum fees for accredited exercise physiology the same way it does for physiotherapy, at the same $148.90 initial and $100.90 follow-up maximums from February 2026. Workers’ compensation exercise physiology NSW 2026 sits inside the scheme on the same footing.

The practitioner requirements run tighter than they do for physiotherapy. An exercise physiologist treating you on a NSW claim must be accredited with Exercise & Sports Science Australia and approved by SIRA. Accreditation on its own is not enough.

One line in the new exclusions deserves attention if anyone has told you exercise physiology is “just a gym programme”. The regulation excludes general health, fitness and recreational activities that a medical practitioner has not prescribed. Clinically justified exercise, delivered by an Accredited Exercise Physiologist under a treatment request and following a doctor’s referral, is a different thing from general fitness, and the referral requirement plus the fee order are what distinguish the two on paper.

When Do You Choose Exercise Physiology vs. Physiotherapy?

The question most injured workers actually want answered is which of the two they can book today, and that turns entirely on the referral. You can ring a physiotherapist yourself. For exercise physiology, your nominated treating doctor has to refer you first.

They also share more than they differ. The request form is identical, the four-consultation allowance is identical, and your insurer applies the same three questions to both. In practice, the two run alongside each other at least as often as one replaces the other, and both are funded from the same claim rather than competing budgets.

Where Healthstin runs both, a worker might see a physiotherapist early for assessment and treatment of the injury itself, with an Accredited Exercise Physiologist picking up conditioning work later in the claim. Hydrotherapy is sometimes used as part of that, delivered by either discipline.

Exercise Physiology Treatment Process Under Reform

Start with the referral, because that is the step that trips people up. Ask your nominated treating doctor for one at your next review rather than booking the exercise physiologist first and sorting the paperwork afterwards.

From there, the process mirrors physiotherapy closely. Up to four consultations can proceed without pre-approval where the injury has not been treated by an Accredited Exercise Physiologist, physiotherapist, chiropractor or osteopath and treatment begins within three months of the injury. The AHTR goes in before those run out, carrying the clinical justification, the goals and the outcome measures. Your insurer then has 21 calendar days.

A handful of items in the exercise physiology fee order always need approval beforehand, whatever stage you have reached. Telehealth-only delivery is one. Report writing is another, and it can only be claimed where the insurer asked for the report in the first place. Travel at 88 cents a kilometre is a third, and it cannot be claimed for a mobile practice or for a facility the practitioner works at regularly.

Telehealth has its own set of rules, which are often more detailed than people realise. Videoconferencing is usually the main method. Email and text can be used as extra support, but they cannot take the place of video visits. In most cases, telehealth needs to be combined with in-person sessions unless your insurer allows telehealth-only care. You also have to want it—the worker must ask for or agree to telehealth, and the practitioner must decide it is right for the injury.

Sources: SIRA accredited exercise physiology fees and practice requirements effective 1 February 2026; SIRA guide for allied health practitioners.

Next Steps: Getting Physiotherapy or Exercise Physiology Under the New Reform

If You’re Newly Injured in 2026

Your claim will be assessed under the new test, so the groundwork is worth doing the first time properly.

Treatment in the first 48 hours needs no approval, so there is no paperwork reason to wait. Tell whoever treats you that it is a work injury, and pass on your claim number as soon as you have one, because the invoice cannot be processed without it. If you want exercise physiology in the mix at some point, raise it with your nominated treating doctor early, since only they can write that referral.

The thing most worth your attention is that first Allied Health Treatment Request. Ask your physiotherapist what outcome measures they are recording and what is going into the request. Under a test that weighs cost against benefit, a request with measurements in it starts from a stronger position than one without.

If You’re Currently in Workers’ Comp

Which test applies to you comes down to timing rather than to anything you have done.

If you claimed treatment before 1 October 2026 and your insurer had not finally determined that claim, the old “reasonably necessary” test still applies to it. The same holds where treatment was approved before October, but you had not started or finished it. Claims for treatment made from 1 October onwards go through the new test, and that includes new requests on a claim that has been open for years.

An existing claim is not grandfathered in any general sense, then. It is each treatment claim that carries a date, not the file as a whole. If your provider is submitting a fresh request this month, expect the three new questions to apply to it. NSW workers’ comp allied health treatment 2026 decisions turn on when the request was made.

One question is worth putting to your provider directly: are we still inside pre-approved sessions, or is a new request due? Asking it tends to prevent the gap where treatment pauses and nobody has told you why.

What If Your Insurer Declines Your Treatment?

A decision you disagree with does not necessarily mean you have run out of options. There are separate pathways for requesting a review, disputing an insurer’s decision and making a complaint.

The first option is an internal review. You can ask the insurer to review its decision. For applicable insurer-review requests, the insurer must complete the review and notify you of the outcome within 14 days of receiving your request. You do not necessarily have to wait for this process to finish before lodging a dispute with the Personal Injury Commission (PIC). Check the relevant decision notice for the applicable process and any time limits.

The second option is a formal dispute. You can lodge a dispute directly with the PIC, an independent tribunal that resolves workers’ compensation disputes. You may be able to do this without first completing an internal review, depending on the type of decision and applicable requirements.

Complaints follow a different pathway. If you have concerns about how your workers’ compensation insurer has handled your claim, contact the Independent Review Office (IRO) on 13 94 76. For complaints about an employer or a health provider, contact the State Insurance Regulatory Authority (SIRA) on 13 74 72. A complaint can raise concerns about how your claim has been handled, but it is not a substitute for formally disputing an insurer’s decision.

Legal assistance may also be available through IRO’s Independent Legal Assistance and Review Service (ILARS).Since 1 July 2026, revised funding criteria apply. Funding is subject to eligibility and assessment requirements, including reasonable prospects of success and the likely benefit of the proposed legal assistance. Contact IRO or an approved lawyer to discuss your circumstances and whether funding may be available.

Take This with You to Your Next Appointment

Most of what’s on this page matters at one particular moment: when you’re sitting in front of your physiotherapist and your treatment request is due. The questions to ask, the session numbers and the review pathways are on a single page you can keep on your phone.

Download the NSW Workers’ Comp 2026 Checklist for Injured Workers

Current at 12 October 2026, with a review date on the face of it.

What the 2026 Reform Means for Your Treatment

The reform did not take physiotherapy or exercise physiology away from injured workers in NSW, and it did not put a ceiling on how much treatment an accepted claim can fund. What it did was move the insurer’s decision point earlier and hand them a sharper test to apply once they get there.

Which makes the paperwork, rather than the legislation, the thing that will actually affect your week. A request that lands before your fourth session with real measurements in it is the difference between treatment that continues and treatment that pauses whilst somebody asks for more information.

Key Takeaways

• The “reasonable and necessary” test started on 1 October 2026, not July 2026, and asks three questions: primary purpose, clinical justification, and cost measured against benefit and alternatives.
• The allied health allowance before insurer pre-approval dropped from eight consultations to four on 1 October 2026.
• Physiotherapy and exercise physiology both remain covered, and the guidelines set no limit on how much treatment an accepted claim can fund.
• You can choose your own practitioner, provided they are SIRA-approved, and you cannot be billed directly or charged a gap fee whilst your treatment is approved.
• Physiotherapy needs no referral. Exercise physiology needs one from your nominated treating doctor.
• Treatment claims made before 1 October 2026 and not finally determined are still assessed under the old test.
• Maximum consultation fees rose roughly four to five per cent from 1 February 2026, and none of that increase is payable by you.

Disclaimer: General information only. This article explains how the NSW workers’ compensation scheme operates as at 12 October 2026 and is not personal clinical, financial or legal advice. Scheme rules are being implemented in stages and can change. Check your own position with your insurer, your nominated treating doctor, or SIRA before acting on anything here.

FAQs About NSW Workers’ Comp Reform 2026

1. Will the reform delay my physiotherapy treatment?

It can bring the insurer’s decision forward rather than add a delay at the end. Because only four consultations now proceed without pre-approval instead of eight, your physiotherapist writes the treatment request earlier in your care. Where that request goes in before the fourth session, treatment usually carries on without a break. Your insurer has 21 calendar days from receiving it to determine liability.

2. Do I have to pay for physiotherapy or exercise physiology under the reform?

Not while your claim is accepted and the treatment is approved. Both fee orders prohibit a provider from billing you directly, adding a gap fee on top of the insurer’s payment, or charging you for a cancelled or missed appointment, and you are not liable for any cost the fee order covers. If your insurer declines to fund further treatment or your entitlement ends, treatment after that point becomes your cost.

3. What is the “reasonable and necessary test”? Does it mean less treatment?

It is the test your insurer applies to treatment claims made from 1 October 2026. Treatment has to be primarily for the injury you claimed for, clinically justified, and reasonable in cost against both the benefit and the alternatives. It does not set a treatment limit. It does mean requests carrying clear clinical reasoning and outcome measures are easier for an insurer to assess than requests without them.

4. How many physiotherapy sessions can I have before the insurer has to approve them?

Four, where the injury has not previously been treated by a physiotherapist, chiropractor, osteopath or Accredited Exercise Physiologist and treatment starts within three months of the injury. That figure was eight until 30 September 2026. Anything your insurer has already pre-approved sits outside the four. There is no overall cap on sessions once a request is approved.

5. Did the treatment rules change in July 2026 or October 2026?

October. The 1 July 2026 changes dealt mainly with primary psychological injury claims, permanent impairment assessments, and the rule that your employer cannot attend your appointments unless you ask them to. The treatment test and the drop from eight pre-approval consultations to four both commenced on 1 October 2026. Pages still citing July for the treatment test are out of date.

6. Does the reform change where I can get treatment: clinic, telehealth or home?

The reform itself did not change the setting rules. Home visits remain funded, on their own fee scale. Telehealth generally has to be combined with in-person sessions unless your insurer approves a telehealth-only arrangement, videoconferencing is the preferred format, and you have to request or consent to it. Your practitioner also has to consider it clinically appropriate for your injury.

7. Can I still choose my physiotherapist or Accredited Exercise Physiologist?

Yes. SIRA’s guide for allied health practitioners states that workers can choose their own treating practitioner, provided that practitioner meets SIRA’s approval requirements. For a physiotherapist that means general AHPRA registration plus SIRA approval. For an exercise physiologist it means ESSA accreditation plus SIRA approval. Nothing in the 2026 reform narrowed that choice.

8. Do I need a referral for exercise physiology?

Yes, from your nominated treating doctor. This is the main practical difference from physiotherapy, which you can book yourself without a referral. If exercise physiology is likely to be part of your recovery, it is worth raising at your next appointment with your nominated treating doctor rather than waiting, because the referral has to be in place before treatment starts.

9. How long will I need physiotherapy or exercise physiology under the reform?

That depends on your injury and is a clinical question rather than a scheme question, so your treating practitioner is the person to ask. What the reform changed is the review rhythm: treatment runs in approved blocks under a request that states the plan, the outcome measures and the expected recovery timeframe. Your practitioner submits a further request when more treatment is clinically justified.

10. What happens if my insurer declines my treatment request?

You have two routes. You can ask the insurer for an internal review, and icare’s guidance says they must respond within 14 days of receiving your request. Or you can lodge a dispute with the Personal Injury Commission, which you may do instead of an internal review rather than only after one. Complaints about an insurer go to the Independent Review Office on 13 94 76.

11. My claim started before October 2026. Which rules apply to me?

It depends on each treatment claim rather than on your file as a whole. Treatment claimed before 1 October 2026 and not finally determined by then stays under the old “reasonably necessary” test, as does treatment approved before October that you had not yet started or finished. Any new treatment request made from 1 October onwards goes through the new test, even on a long-running claim.

12. Is remedial massage still covered under Workers’ compensation?

Only where a medical practitioner has prescribed it, and even then it must still satisfy the reasonable and necessary test. From 1 October 2026 the regulation lists massage among the services an insurer cannot approve or pay for without that prescription. If massage has been part of your treatment, speak to your nominated treating doctor about whether a prescription is clinically appropriate for your injury.

Start Physiotherapy or Exercise Physiology on Your NSW Claim

Booking an assessment gets you three practical things: a written record of where your injury sits now, with the measurements your insurer will be looking for; a treatment plan built around what your claim can fund; and an Allied Health Treatment Request prepared and submitted by a team that does it every week.

Healthstin’s physiotherapists and Accredited Exercise Physiologists work with workers’ compensation claims alongside NDIS, DVA and aged care funding, from clinics at Sans Souci and Hurstville in Sydney. Home visits are available in some areas.

You do not need your referral or claim paperwork sorted before you get in touch. Tell us where things are up to and we will tell you what is needed next.

Book an assessment online, call 1300 090 931, or contact us. Providers and nominated treating doctors can use our referral form.