WorkCover Exercise Physiology Reports in NSW: What iCare and SIRA Reviewers Want to See

Most AEPs working in the NSW workers compensation scheme don’t get knocked back because their clinical work is poor. They get knocked back because their notes don’t give reviewers what they need to approve continued treatment.

Key takeaways

• iCare is the insurer; SIRA sets the rules. Both expect documentation built around five Clinical Framework principles.
• The AHTR replaced the old AHRR in June 2024 and became mandatory from December 2024.
• You get up to 8 sessions without pre-approval if treatment starts within 3 months of injury. After that, only 3.
• Outcome measures must be dated and scored. “Progressing well” won’t cut it.
• Progress notes need seven specific elements; missing any one stalls your approval.

What the scheme actually asks for

iCare (Insurance & Care NSW) is the NSW Government insurer that manages most workers compensation claims. SIRA (the State Insurance Regulatory Authority) sets the rules every provider must follow. SIRA’s fee schedule and treatment guidelines govern what iCare approves, so your documentation needs to satisfy both.

To work in the scheme you need a SIRA provider number, ESSA accreditation, and completion of the SIRA Allied Health Practitioner Introductory Training Program. The fee schedule (effective 1 February 2026) sets the initial consultation at $148.90 excl. GST and subsequent sessions at $100.90 excl. GST. Without pre-approval you can deliver up to 8 sessions when the injury is previously untreated and treatment starts within 3 months of injury, or up to 3 sessions when treatment starts after that point. Beyond those limits you need an approved AHTR.

The AHTR (Allied Health Treatment Request) replaced the old AHRR in June 2024 and became mandatory from December 2024. It’s your clinical argument for why continued treatment is warranted, and it lives or dies on the quality of your progress notes.

Everything in the scheme runs through five Clinical Framework principles:

1. Measure and demonstrate treatment effectiveness using validated outcome measures.
2. Adopt a biopsychosocial approach, accounting for physical, psychological, and social factors.
3. Empower the client to self-manage their condition.
4. Keep goals focused on function, participation, and return to work.
5. Base treatment on the best available evidence.

Reviewers apply these principles to every AHTR. If any principle is absent or thinly addressed, the request looks weak.

What goes in your progress notes

Seven elements belong in every progress note and AHTR submission:

1. Current clinical presentation
2. Progress since the last treatment block
3. Barriers to recovery
4. Validated, scored outcome measure results, with dates
5. Person-centred functional goals
6. Self-management strategies the client is completing
7. Work-capacity information

The most common omissions: undated or missing outcome measures, goals written around the treatment activity rather than the function, and no documented self-management plan. These aren’t unusual errors; they’re the reason most delays happen.

Vague language is the other problem. “Client is progressing well” tells a reviewer nothing. Does the client’s pain score sit at 3/10, down from 7/10 at baseline? Say that. Is the client now completing a 20-minute walk without rest breaks, compared to 5 minutes at intake? Write it. Reviewers weren’t in your session. They read what you send.

Invoices must also be submitted within 30 days of service. Late billing is its own rejection pathway, separate from the clinical content. See our breakdown of the most common WorkCover report mistakes for a full list of what trips AEPs up.

Outcome measures: how to record them

Reviewers expect validated, scored measures appropriate to the client’s injury and work demands, recorded with a date and a baseline-versus-current comparison. Not clinical impressions. Not narrative summaries.

Format matters as much as tool choice. Record the measure name, the date administered, and the score. A score with a date is useful. “Client reports difficulty with work tasks” is not. Baseline scores from your initial consultation are your comparison point, and every subsequent entry should show direction: improved, unchanged, or declined, with the numbers behind it.

If your notes lack dated scores, your AHTR is missing its backbone. See our guide on writing compliant progress notes for documentation templates you can adapt.

Self-management and return-to-work

The Clinical Framework requires evidence that you’ve actively empowered the client to manage their own recovery, not a statement that you intend to. Document the home program in specific terms: exercises prescribed, sets, reps, frequency, and whether the client is completing it. “Client was educated on home exercise program” is not documentation.

For any client with a return-to-work goal, document work capacity with numbers. What can the client do? What physical barriers remain? If the client is on modified duties, what capacity have they regained? A functional observation without a benchmark is a sentence without a point.

Name barriers to recovery rather than implying them. Psychological barriers (fear-avoidance, low recovery expectancy), social barriers (work environment, financial pressure), and physical barriers (deconditioning, pain sensitivity) all factor into the biopsychosocial picture. Naming them shows a reviewer you understand the whole case. For more on how this applies across allied health documentation, see our piece on allied health referral letters.

Cutting documentation time without cutting corners

A busy caseload means progress notes, treatment requests, and outcome-measure collation all stack up between appointments. Rushed notes carry more omissions, and omissions mean delays, phone calls to case managers, and resubmissions. The fix isn’t working faster. It’s a repeatable structure: the same seven elements, dated measures, and function-first goals in every note, so nothing slips under time pressure.

AI clinical assistants can help here too. Tools like Kitt draft your clinical notes, treatment plans, and letters from the session, so the writing itself takes less time and your non-contact hours go to reviewing rather than typing. You stay responsible for the clinical content and for what gets submitted. For a fuller look at where these tools fit, see our piece on AI scribes in allied health.

Frequently asked questions

What is the difference between iCare and SIRA for exercise physiologists?

iCare (Insurance & Care NSW) is the insurer managing most NSW workers compensation claims. It funds your sessions and processes your invoices. SIRA (State Insurance Regulatory Authority) is the regulator that sets the fee schedule, session limits, and treatment guidelines that govern what iCare approves. When you’re building a case for continued treatment, you’re writing to satisfy SIRA’s Clinical Framework requirements, which iCare uses to assess your AHTR.

When do I need to submit an AHTR?

Once you’ve used your initial session allocation (up to 8 sessions for previously untreated injuries starting within 3 months, or up to 3 sessions when treatment starts after that point), you need an approved AHTR to continue funded treatment. Submit before you exhaust your sessions. Submitting after creates a funding gap.

What outcome measures do reviewers expect?

There’s no single mandated list. Reviewers expect validated, scored measures appropriate to the client’s injury and work demands, recorded with a date and a baseline-versus-current comparison. The specific tools matter less than using them consistently and recording the name, the date, and the score every time you administer them.

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Strong documentation is a structure you repeat, not a sprint you survive. If you want the writing itself to take less time, an AI clinical assistant like Kitt drafts your notes, treatment plans, and letters from the session so you can spend your non-contact hours reviewing instead. Free for 30 days, no credit card needed.