Dr Henry Pollard
Sports & Exercise Chiropractor
PhD, MExSportSc, Grad Dip AppSc, Grad Dip Chiro, BSc, ICSSD, FICC, FAICE (2019)
SIRA NSW Independent Chiropractic Consultant (2003 to present)
drhenrypollard@gmail.com
https://orcid.org/0000-0003-0269-5697
The NSW workers’ compensation scheme changed from 1 July 2026. SIRA has advised stakeholders that the reforms require updated operational processes, business systems and communication materials, including the use of current documents such as the Workers’ Injury Claim Form and Decision Notice Summary.
Chiropractors remain one of the allied health practitioner groups that must be SIRA-approved to provide specified services in the NSW workers’ compensation system. The changes mean that compensation-funded chiropractic care now needs to be more clearly documented, more explicitly justified and more visibly connected to recovery, function and return to work.
SIRA states that the reforms affect how injuries are assessed, how claims are managed and what support is available to people injured at work. The practical effect depends on the type of injury and when the claim was made or notified. Chiropractors should therefore pay closer attention to claim status, injury classification, treatment approval requirements and the clinical reasoning used to support ongoing care.
The Central Test: Reasonable and Necessary Care
The phrase reasonable and necessary is becoming central in determining treatment for the injured worker, although the change is transitional rather than immediate. SIRA has confirmed that updated wording in Part 4 of the Workers’ Compensation Guidelines is for consultation only from 1 July 2026 and will not commence until a later version of the Guidelines takes effect in October 2026, when the relevant sections of the Workers’ Compensation Legislation Amendment Act 2025 commence. Until then, the current reasonably necessary test continues to apply. Chiropractors should treat the next several months as a preparation window rather than an immediate compliance deadline.
Separately, completing the Allied Health Treatment Request remains a condition of approval for SIRA-approved allied health practitioners providing specified services in the scheme.
The wording matters, and it is worth preparing for now even though it is not yet the operative test. A shift from ‘reasonably necessary’ to ‘reasonable and necessary’ will raise the practical threshold once it commences, because the test will no longer be easily treated as a single broad question. It will separate the issue into two linked questions: is the treatment reasonable in type, timing, frequency, cost and clinical context, and is it also necessary because of the compensable injury at this stage of recovery?
For chiropractors, this means care may be clinically reasonable but still fail the necessity test. Manual therapy may be reasonable for short-term symptom modulation, but further treatment may not be considered necessary if the worker has plateaued, functional capacity is unchanged, active self-management has not progressed, or the proposed care is not clearly linked to return-to-work goals. Conversely, treatment may appear necessary because the worker still has pain, but it may not be reasonable if the frequency is excessive, the duration is open-ended, the goals are vague, or similar care has already failed to produce measurable change.
The clinical record should therefore show why treatment is required, how it relates to the accepted or alleged work injury, what functional limitation remains and what the next block of care is expected to change. A good compensation file should answer a simple question: if another practitioner, insurer or independent consultant reviewed the record, could they see why treatment was needed, what it was trying to achieve, whether it was working and when it would be reduced or ceased?
Manual therapy may still be appropriate, but it should be framed against both parts of the test. It is easier to justify when it improves movement tolerance, supports graded loading, reduces pain sensitivity, assists confidence in movement or enables return-to-work progression. It is harder to justify when it is documented only as repeated symptom relief.
The AHTR Must Tell the Clinical Story
The Allied Health Treatment Request (AHTR) will become increasingly important in chiropractic compensation practice. SIRA describes the AHTR as the form used by allied health practitioners to request prior approval for treatment and services and to communicate with the insurer about treatment, timeframes and anticipated outcomes.
The AHTR should not be treated as an administrative formality. It should briefly but clearly describe the injury, working diagnosis, functional limitations, treatment response, outcome measures, barriers to recovery, treatment plan and expected outcomes. SIRA’s explanatory notes direct SIRA-approved chiropractors and other allied health practitioners to provide their approval number, document the compensable injury or diagnosis, record current clinical signs and symptoms, and use risk screening where appropriate.
A vague request for ‘further treatment to reduce pain and improve function’ is unlikely to be persuasive. A stronger request identifies the functional target: improved lifting tolerance, longer standing capacity, better work-hour tolerance, reduced disability score, safer bending confidence or progression to self-management.
| What decision-makers need to understand | What the chiropractic record or AHTR should show |
|---|---|
| What injury is being treated? | Accepted or alleged injury and clear working diagnosis. |
| Why is treatment needed? | Current impairment, functional limitation or work restriction. |
| Has treatment helped? | Change in pain, function, PROMs, work tolerance or activity capacity. |
| Why this treatment dose? | Proposed sessions, frequency, timeframe and rationale. |
| What is the goal? | Specific functional and work-related outcomes. |
| Why is care both reasonable and necessary? | Explanation of why the care is proportionate and why it remains required because of the work injury. |
| When will treatment change or stop? | Review points, tapering plan, discharge criteria or referral triggers. |
Documentation Must Move Beyond Pain Scores
Pain scores remain useful, but they are not enough. Workers’ compensation care is concerned with recovery, function and safe participation in work. Chiropractors should record what the worker can and cannot do: sitting, standing, lifting, carrying, walking, driving, reaching, bending, sleeping, working hours and usual duties.
Outcome measures can strengthen this process. Tools such as the ODI, NDI, QuickDASH, LEFS and PSFS help show whether treatment is changing disability and capacity, not only symptoms. The ÖMPSQ-SF should be used to screen for psychosocial risk factors associated with delayed recovery. The treatment plan should also demonstrate progression. Early care may focus on pain modulation, reassurance and restoration of tolerable movement. As the claim progresses, care should usually shift toward exercise, graded exposure, work simulation, pacing, self-management and reduced treatment frequency.
Repeating the same passive intervention at the same frequency without measurable functional change will become increasingly difficult to defend.
Communication is Part of Good Compensation Care
A chiropractor treating an injured worker is part of a broader recovery pathway. The worker, employer, insurer, nominated treating doctor, workplace rehabilitation provider and other treating practitioners may all be involved. Clear communication reduces duplication, inconsistent advice and unnecessary disputes.
This does not mean excessive reporting. It means relevant reporting. When chiropractic findings affect diagnosis, capacity, treatment direction, recovery expectations or referral needs, those findings should be communicated in shared clinical language. The file should make clear what is being treated, why it matters, what has changed and what should happen next.
| Area | What chiropractors should strengthen |
|---|---|
| Diagnosis | Use clear clinical terminology and link findings to the work injury. |
| Functional baseline | Record work and activity limitations at the start of care. |
| Outcome measurement | Use relevant PROMs and task-based measures. |
| Treatment rationale | Explain why care is both reasonable and necessary. |
| Manual therapy | Document its role as an adjunct to movement, loading and function. |
| Active care | Show progression toward exercise, pacing and self-management. |
| Communication | Update relevant parties when capacity or treatment direction changes. |
| Review and discharge | Include tapering, discharge criteria and escalation triggers. |
SIRA Documents and Links Chiropractors Should Use
| Document or resource | Why it matters for chiropractors | Link |
|---|---|---|
| SIRA Workers’ Compensation Information Hub | Overview of the 1 July 2026 reforms and how they affect workers, employers, insurers and service providers. | Workers' compensation information hub |
| Workers’ Compensation Reform FAQs | Explains the legislative changes, including how injuries are assessed and claims are managed. | Workers' compensation reform FAQs |
| Workers’ Compensation Guidelines 2026 | The main operational guideline set for the scheme from 1 July 2026. | Workers' Compensation Guidelines |
| Allied Health Treatment Request page | Explains the AHTR and when it is required. | Allied Health Treatment Request |
| AHTR form | The core form chiropractors use to request treatment approval. | Allied Health Treatment Request form PDF |
| AHTR downloads page | Provides access to different file types and related AHTR resources. | AHTR downloads |
| AHTR explanatory notes | Helps practitioners complete the AHTR properly, including diagnosis, signs and symptoms, risk screening and outcome measures. | AHTR explanatory notes |
| Workers' compensation forms page | Central page for current SIRA forms, including the Worker’s Injury Claim Form, Certificate of Capacity and other scheme documents. | Workers compensation forms |
| Physiotherapy, Chiropractic and Osteopathy Fees and Practice Requirements 2026 | Sets out binding fee and practice requirements for chiropractic services in the workers compensation scheme. | 2026 Physiotherapy, Chiropractic and Osteopathy Fees and Practice Requirements PDF |
| Fees paid for workers’ compensation health services | Provides current fee-order access and invoicing requirements. | Fees paid for workers compensation health services |
| Independent Consultants for Workers’ Compensation | Explains the independent consultant role when treatment duration, frequency, functional progress or recovery barriers are questioned. | ndependent consultants for workers compensation |
| Decision Notice Summary | Mainly an insurer document, but chiropractors should know it because treatment, liability or work capacity decisions may be communicated using this approved form.https://www.chiropractors.org.au/wp-admin/post-new.php?post_type=responsive_table# | Decision notice summary approved form |
Psychological Factors Still Matter
The reforms include significant changes for primary psychological injury claims. The 2026 Workers’ Compensation Guidelines state that recent legislative reforms introduce new eligibility requirements and thresholds for workers’ compensation benefits for primary psychological injuries notified to the employer after 1 July 2026. Chiropractors will usually not be making statutory decisions about psychological injury, but psychological and social factors frequently influence musculoskeletal recovery.
Fear avoidance, poor sleep, low confidence, workplace conflict, distress and delayed recovery beliefs should be recorded when they affect function or return to work. Where these barriers are significant, communication with the nominated treating doctor, insurer, psychologist or workplace rehabilitation provider may be appropriate.
Independent Consultant Review Should Be Expected, Not Feared
Independent consultants may be involved where there are questions about treatment duration, frequency, functional progress, work focus or barriers to recovery. SIRA describes independent consultants as allied health practitioners who provide independent peer review of treatment in the NSW workers’ compensation scheme.
For treating chiropractors, the lesson is straightforward: make the file review ready. A reviewer should be able to identify the diagnosis, injury relationship, treatment provided, response to care, functional progress, active-care component, barriers to recovery and plan for tapering or discharge.
Likely Influence Beyond NSW
Although these reforms apply to the NSW workers’ compensation scheme, they are likely to be watched closely by other Australian jurisdictions. Workers’ compensation systems differ between states and territories, but they face similar pressures: scheme sustainability, delayed recovery, psychological injury growth, treatment duration, return-to-work outcomes and the need for clearer clinical accountability.
For chiropractors practising outside NSW, the reforms should therefore be read as a signal of the likely direction of travel rather than as a NSW-only issue. Other jurisdictions may not adopt the same forms, thresholds or approval rules, but the underlying expectations are likely to be similar: clearer diagnosis, stronger functional measurement, better treatment justification, active rehabilitation, communication with relevant parties, and planned tapering or discharge.
The practical message for the profession is that NSW may become an early indicator of broader compensation-sector expectations. Chiropractors who improve their documentation, outcome measurement and treatment reasoning now will be better prepared if similar standards emerge in other Australian schemes.
What the Profession Should Do Now
The reforms create a practical education task for the profession. Associations, CPD providers and universities can assist by offering worked examples of strong AHTRs, model wording for reasonable-and-necessary treatment requests, guidance on outcome-measure selection, case-conference communication and discharge planning.
This is not simply compliance. It is a professional standard. Chiropractic care is easier to understand, support and defend when the reasoning is clear and the outcomes are measurable.
Conclusion
The 1 July 2026 NSW workers’ compensation reforms do not exclude chiropractors from the scheme. They do raise the documentation and justification threshold, and the reasonable and necessary test will raise it further once it commences in October 2026. Together, these changes may also foreshadow broader expectations across Australian compensation systems.
The safest response is clear practice: diagnose carefully, link care to the work injury, measure function, use manual therapy purposefully, progress active rehabilitation, communicate when needed and plan for tapering or discharge.
Chiropractic care will be best placed in the new environment when it is clinically useful, functionally directed, well communicated and clearly documented.
REFERENCES
- State Insurance Regulatory Authority. Key workers compensation changes commence 1 July [Internet]. Sydney: SIRA; 2026 Jun 26 [cited 2026 Jul 6]. Available from: https://www.sira.nsw.gov.au/news/key-workers-compensation-changes-commence-1-july
- State Insurance Regulatory Authority. Workers compensation reform FAQs [Internet]. Sydney: SIRA; 2026 [cited 2026 Jul 6]. Available from: https://www.sira.nsw.gov.au/workers-compensation/workers-compensation-reform-faqs