NSW employers are partway through a two-year freeze on the state’s target workers compensation premium collection rate. The fees doctors charge to treat injured workers are not covered by that freeze, and they were reset again on November 1, 2026.
That was the date a new edition of the Australian Medical Association (AMA) Fees List took effect. The State Insurance Regulatory Authority (SIRA) adopts the list’s fees in NSW compensation schemes.
The exceptions are fees in the Workers Compensation (Medical Practitioner Fees) Order 2026 or the Workers Compensation (Surgeon and Orthopaedic Surgeon Fees) Order 2026.
Practitioners must invoice under the AMA Fees List that is current on the date a service is delivered. Treatment from 1 November 2026 onwards therefore falls under the new edition.
A legislated freeze on the target collection rate keeps the Nominal Insurer’s figure at 1.99% for the 2026-27 and 2027-28 premium years. Individual employers’ NSW workers compensation premiums can still shift with their wages and claims experience, however.
Read more: Workers compensation fraud conviction as NSW regulator ramps up enforcement
Average workers compensation premium rates rose 8% in both 2024-25 and 2025-26. icare attributed those increases to growing numbers of psychological claims, higher weekly benefits and medical costs, and more claims reaching higher whole person impairment levels.
The Nominal Insurer recorded a $3.2 billion underwriting loss in 2024-25, according to icare’s annual report. Net claims expenses reached $7.62 billion, against gross written premium of $5.4 billion.
SIRA usually indexes its own fees orders each February. Its medical and surgical fees orders rose 4.49% from February 1, 2025.
Nine orders started on February 1, 2026, among them the 2026 medical practitioner and surgeon orders. That round did not index maximum fees set by the AMA Fees List, because the AMA had already indexed them on November 1, 2025.
The February orders also set the provider travel rate at $0.88 per kilometre. That rate matches the Australian Taxation Office’s cents-per-kilometre method for 2025-26.
The AMA Fees List has been published since 1974, and a new indexed edition comes out each 1 November. Indexation follows the AMA Medical Fees Index, a weighted average that draws on three Australian Bureau of Statistics macroeconomic indices.
Fees on the list rose 3.45% in November 2022. A further 2.13% adjustment in early March 2023 brought the total 2022 indexation to 5.58%. The November 2023 indexation was 4.57%.
SIRA’s notice does not state the size of the 2026 increase.
Within NSW workers compensation, the AMA amounts that the fees orders adopt act as maximum fees. Where either fees order sets its own figure, that figure applies instead.
Since October, a separate standard has applied before insurers approve payment for treatment. Claims for medical or related treatment, hospital treatment, ambulance services and workplace rehabilitation must now be “reasonable and necessary”.
That replaces the earlier “reasonably necessary” threshold, and the Law Society of NSW told SIRA in May that it could not support the change.
The new test applies to treatment claims made on or after 1 October 2026. Claims made before that date can continue under the earlier test in specified circumstances. nsw
SIRA has issued directions to seven health and rehabilitation providers over billing non-compliance. Six are approved workplace rehabilitation providers whose invoicing was found to be non-compliant after investigations.
The six are Actual Rehab, Ability Group (trading as Health Ability), Ipar Rehabilitation, Platinum Rehabilitation Group, Rehabilitation Services and Workplace O H & S Solutions. Each of the six received a direction under section 26D(1)(a) of the State Insurance and Care Governance Act 2015.
I-MED New South Wales must provide invoices and reimbursement evidence for every MRI service it charged to the NSW workers compensation scheme. That direction took effect on 1 September 2026 and runs until 30 July 2027.
Read next: NSW workers comp providers face orders over billing failures
In South Australia, a ReturnToWorkSA consultation paper proposed 4.9% indexation for attendances and other medical items in 2026-27. The proposal follows the change in average private charges in 2024-25.
WorkSafe Victoria reimburses medical practitioners on the basis of Medicare Benefits Schedule item numbers, definitions, rules and conditions.
SIRA also has three projects on health provider regulation in workers compensation and CTP. They cover a Strategic Review of Health Provider Regulation, a review of the Certificate of Capacity/Certificate of Fitness, and a medical practitioner efficacy research project.
The strategic review has since commenced, and it covers providers in both the workers compensation and CTP motor accident schemes.
