Motor Vehicle and Workplace Accidents (Catastrophic Injuries) Regulations 2016 (Western Australia)

Mechanically, these regulations prescribe the operational rules for the Motor Vehicle and Workplace Accidents (Catastrophic Injuries) Scheme (CISS) created by the Act. They (a) set objective medical and functional criteria for what constitutes a catastrophic injury (see Part 2 Division 1, regs 7-11); (b) specify application mechanics, timing and evidence rules for participation in the CISS (regs 12-18); (c) set the interim participation period and suspension grounds (regs 19-21); (d) provide principles and procedural powers for assessing treatment, care and support needs, and impose obligations on participants and service providers to supply information and undergo examinations (Part 3, regs 22-25); (e) identify the categories of services to be delivered through registered providers and set registration, variation and revocation mechanics (Part 4, regs 26-30); and (f) establish a layered dispute-resolution system built around internal review officers for non‑medical decisions and ministerially appointed expert review panels for medical decisions and assessment disputes (Part 5, regs 31-63). The Schedule enumerates services that are expressly excluded from the CISS (Schedule 1).

The regulations supply operational detail the Act refers to: specifying assessment tools (ASIA, FIM, WeeFIM, Glasgow Coma Scale, Westmead PTA Scale, Snellen Scale) and the thresholds or test‑based criteria that convert clinical findings into eligibility for CISS participation (regs 4, 7-11). They also set time limits: an application under s 9 of the Act must be made within three years of the relevant accident unless the Commission extends the period for exceptional reasons (reg 12); interim participation is generally two years unless the Commission extends for stabilisation (reg 19).

The regulations also allocate decision‑making and administrative responsibilities. The Minister appoints medical experts and a convenor/deputy convenor, and maintains an experts list (regs 51-53). The Commission implements and enforces the scheme: receiving and assessing applications, deferring until injuries stabilise (reg 13), requesting further information (regs 15-16), registering providers (regs 26-30) and convening reviews (regs 31-49). Expert review panels are given powers to require examinations, information and attendance, with penalties for non‑compliance (regs 57-59).

CrestWestern Australia

Motor Vehicle and Workplace Accidents (Catastrophic Injuries) Act 2016

Motor Vehicle and Workplace Accidents (Catastrophic Injuries) Regulations 2016

Western Australia

Motor Vehicle and Workplace Accidents (Catastrophic Injuries) Regulations 2016

Contents

Part 1 — Preliminary

Citation 1
Commencement 1
Terms used 1
Assessment tools 3
Excluded treatment, care and support needs 3

Part 2 — Participation in CISS

Division 1 — Criteria for catastrophic injury

Purpose of Division 4
Spinal cord injury 4
Traumatic brain injury 4
Amputations 6
Burns 7
Permanent blindness 9

Division 2 — Application to participate in CISS

Application under s. 9 of Act 9
Deferral of consideration of application 10
Application under s. 13 of Act 10
Additional information relevant to CISS application 10
Consent to obtain information 11
Notice of decision on CISS application 11
Functional independence assessments 11

Division 3 — Interim participation

Period of interim participation 12

Division 4 — Suspension of participation

Commission may suspend participation 12
Notice of decision to suspend 13

Part 3 — Treatment, care and support needs

Principles to be observed in assessment of treatment, care and support needs 14
Requirement to provide information 15
Requirement to undergo examination 15
Participant to comply with requirements in treatment, care and support assessment 16

Part 4 — Registered providers

Services to be provided by registered provider 17
Application for registration 17
Notice of decision on application 18
Variation, addition or cancellation of conditions of registration 18
Revocation of registration 18

Part 5 — Dispute resolution

Division 1 — Review applications

Review application 19
Commission may request further information 19

Division 2 — Review of non‑medical decisions

Referral of decision to review officer 20
Objection to review officer 20
Conduct of review 20
Decision on review 21
Review officers 21

Division 3 — Review of medical decisions

Referral of decision to expert review panel 21
Decision of expert review panel 22
Application for review of original review decision 22
Referral of original review decision to another expert review panel 23
Decision of second review panel 23
Effect of decision of second review panel 24
Commission to reimburse treatment, care and support expenses in certain circumstances 24

Division 4 — Review of treatment, care and support assessments

Term used: assessment 25
Referral of decision to expert review panel 25
Decision of expert review panel 25
Effect of decision of expert review panel 25
Commission to revise assessment 26

Division 5 — Expert review panels

Establishment 26
Appointment of medical experts 26
Experts list 27
Convenor and deputy convenor 27
Constitution of expert review panel 28
Convenor to give notice of members of panel 28
Objection to member of panel 28
Procedures: general provisions 29
Acts and decisions of 2 or 3 member panel 29
Powers and procedures on review 30
Use of information in subsequent proceedings 31
Admissibility 31
Services and facilities 31
Guidelines 32

Division 6 — Other matters

Costs 32
Extension of period for application or objection 32
Correction of errors 33
Period for commencing appeal 33

Schedule 1 — Excluded treatment, care and support needs

Terms used 34
Attendant care services 34
Domestic assistance 34
Aids and appliances 35
Education support 35
Vocational or workplace support 35
Home modifications 36
Transport modifications 37
Respite care 37
Prostheses 38

Notes

Compilation table 39

Other notes 39

Defined terms

Motor Vehicle and Workplace Accidents (Catastrophic Injuries) Act 2016

Motor Vehicle and Workplace Accidents (Catastrophic Injuries) Regulations 2016

Part 1 — Preliminary

1. Citation

	These regulations are the *Motor Vehicle and Workplace Accidents (Catastrophic Injuries) Regulations 2016*.

[Regulation 1 amended: SL 2024/133 r. 4.]

2. Commencement

These regulations come into operation on the day on which section 34 of the Act comes into operation.

3. Terms used

In these regulations, unless the contrary intention appears —

application for registration means an application for registration under section 23 of the Act;

ASIA Impairment Scale has the meaning given in regulation 4(1);

CISS application means an application made under section 9(1) or 13 of the Act;

Commission officer means —

(a) a person appointed as an officer or employee of the Commission under the Insurance Commission of Western Australia Act 1986 section 12(1); or

(b) a person engaged by the Commission under section 12(4) of that Act;

conditions of registration means conditions determined under section 23(5) of the Act in respect of a registration;

expert review panel means an expert review panel constituted under Part 5 Division 5;

experts list means the list referred to in regulation 52(1);

FIMTM has the meaning given in regulation 4(2);

Glasgow Coma Scale has the meaning given in regulation 4(3);

injured person, in relation to an expert review panel, means the injured person to whom the proceedings before the panel relate;

medical decision means —

(a) a decision referred to in paragraph (a)(iv) of the definition of eligibility decision in section 24 of the Act; or

(b) a decision referred to in paragraph (a)(iii) of that definition if the decision does not involve a question of law or a question of mixed fact and law;

non‑medical decision means —

(a) a decision referred to in paragraph (a)(i) or (ii) or (b) of the definition of eligibility decision in section 24 of the Act; or

(b) a decision referred to in paragraph (a)(iii) of that definition if the decision involves a question of law or a question of mixed fact and law;

original review decision means a decision made under regulation 39(1);

referred decision, in relation to an expert review panel, means a decision referred to the panel under Part 5 Division 3 or 4;

review application means an application made under section 25 or 26 of the Act;

review officer means a person designated as a review officer under regulation 37;

second review panel has the meaning given in regulation 41(3);

Snellen Scale has the meaning given in regulation 4(4);

WeeFIM® has the meaning given in regulation 4(5);

Westmead Post‑Traumatic Amnesia Scale has the meaning given in regulation 4(6).

4. Assessment tools

(1) The ASIA Impairment Scale is the scale known by that name that is used to describe a person’s functional impairment as a result of a spinal cord injury.

(2) The FIMTM is the instrument known by that name that is used to assess a person’s functional independence.

(3) The Glasgow Coma Scale is the scale known by that name that is used to assess a person’s response to stimuli after a head injury.

(4) The Snellen Scale is the standardised test known by that name that is used to measure a person’s visual acuity.

(5) The WeeFIM® is the instrument known by that name that is similar to the FIMTM but adapted for paediatric use.

(6) The Westmead Post‑Traumatic Amnesia Scale is the standardised test known by that name that is used to measure a person’s post‑traumatic amnesia.

5. Excluded treatment, care and support needs

The care, support and services listed in Schedule 1 are prescribed for the purposes of the definition of excluded treatment, care and support needs in section 3(1) of the Act.

Part 2 — Participation in CISS

Division 1 — Criteria for catastrophic injury

6. Purpose of Division

This Division sets out the criteria for eligibility for participation in the CISS for the purposes of the definition of catastrophic injury in section 3(1) of the Act.

7. Spinal cord injury

The criteria for a spinal cord injury are —

(a) the injury results in permanent neurological deficit as evidenced by an ASIA Impairment Scale score of A to D conducted as part of a medical assessment; and

(b) the injury occurs —

(i) if the injury is a motor vehicle injury — on or after 1 July 2016; or

(ii) if the injury is a workplace injury — on or after 1 July 2024.

[Regulation 7 amended: SL 2024/133 r. 5.]

8. Traumatic brain injury

(1) The criteria for a traumatic brain injury suffered by a person who has reached 8 years of age at the time of medical assessment are —

(a) either or both of the following —

(i) a recorded post‑traumatic amnesia of 7 days or more measured using the Westmead Post‑Traumatic Amnesia Scale or a similar clinically accepted, validated scale for post‑traumatic amnesia;

(ii) a significant brain imaging abnormality or evidence of a very significant impact to the head causing coma for longer than one hour;

and

(b) a score of 5 or less on any item on the FIMTM or WeeFIM® due to the injury; and

(i) if the injury is a motor vehicle injury — on or after 1 July 2016; or

(ii) if the injury is a workplace injury — on or after 1 July 2024.

(2) The criteria for a traumatic brain injury suffered by a person who has reached 3 years of age but is under 8 years of age at the time of medical assessment are —

(a) one or more of the following —

(i) a Glasgow Coma Scale score of less than 9 (assessed after resuscitation or on admission to the emergency department of a hospital);

(ii) a recorded post‑traumatic amnesia of 7 days or more measured using the Westmead Post‑Traumatic Amnesia Scale or a similar clinically accepted, validated scale for post‑traumatic amnesia;

(iii) a significant brain imaging abnormality or evidence of a very significant impact to the head causing coma for longer than one hour;

and

(b) a score 2 less than the age norm on any item on the WeeFIM® due to the injury; and

(i) if the injury is a motor vehicle injury — on or after 1 July 2016; or

(ii) if the injury is a workplace injury — on or after 1 July 2024.

(3) The criteria for a traumatic brain injury suffered by a person who is under 3 years of age at the time of medical assessment are —

(a) a medical certificate from a paediatric rehabilitation physician or specialist that states the person will probably have permanent impairment due to the injury resulting in a significant adverse impact on the person’s normal development; and

(b) the injury occurs —

(i) if the injury is a motor vehicle injury — on or after 1 July 2016; or

(ii) if the injury is a workplace injury — on or after 1 July 2024.

[Regulation 8 amended: SL 2024/133 r. 6.]

9. Amputations

(1) The criteria for an injury resulting in amputation, or the equivalent impairment, are —

(a) the criteria set out in subregulation (2); and

(b) the injury occurs —

(i) if the injury is a motor vehicle injury — on or after 1 July 2016; or

(ii) if the injury is a workplace injury — on or after 1 July 2024.

(2) For subregulation (1)(a), the criteria are —

(a) a brachial plexus or lumbosacral avulsion equivalent to an amputation; or

(b) one amputation of either of the following types —

(i) forequarter amputation or shoulder disarticulation;

(ii) amputation of a lower limb at or above 65% of the femur;

(i) amputation of a lower limb at or above 50% of the tibia;

(ii) amputation of an upper limb at or above the first metacarpophalangeal joint of the thumb and index finger of the same hand.

[Regulation 9 amended: SL 2024/133 r. 7.]

10. Burns

(1) The criteria for a burns injury suffered by a person who has reached 8 years of age at the time of medical assessment are —

(a) the criteria set out in subregulation (4); and

(b) a score of 5 or less on any item on the FIMTM or WeeFIM® due to the injury; and

(i) if the injury is a motor vehicle injury — on or after 1 July 2016; or

(ii) if the injury is a workplace injury — on or after 1 July 2024.

(2) The criteria for a burns injury suffered by a person who has reached 3 years of age but is under 8 years of age at the time of medical assessment are —

(a) the criteria set out in subregulation (4); and

(b) a score 2 less than the age norm on any item on the WeeFIM® due to the injury; and

(i) if the injury is a motor vehicle injury — on or after 1 July 2016; or

(ii) if the injury is a workplace injury — on or after 1 July 2024.

(3) The criteria for a burns injury suffered by a person who is under 3 years of age at the time of medical assessment are —

(a) the criteria set out in subregulation (4); and

(b) a medical certificate from a paediatric rehabilitation physician or specialist that states the person will probably have permanent impairment due to the injury resulting in a significant adverse impact on the person’s normal development; and

(i) if the injury is a motor vehicle injury — on or after 1 July 2016; or

(ii) if the injury is a workplace injury — on or after 1 July 2024.

(4) For subregulations (1)(a), (2)(a) and (3)(a), the criteria are —

(a) full thickness burns greater than 40% of total body surface area or, for a person under 16 years of age, greater than 30% of total body surface area; or

(b) inhalation burns causing long‑term respiratory impairment (as assessed by a respiratory physician); or

[Regulation 10 amended: SL 2024/133 r. 8.]

11. Permanent blindness

The criteria for an injury resulting in blindness are —

(a) permanent legal blindness as demonstrated by —

(i) visual acuity on the Snellen Scale after correction by suitable lenses being less than 6/60 in both eyes; or

(ii) field of vision being constricted to 10 degrees or less of arc around central fixation in the better eye irrespective of corrected visual acuity (equivalent to 1/100 white test object); or

(iii) a combination of visual defects resulting in the same degree of visual loss described in subparagraph (i) or (ii);

and

(b) the injury occurs —

(i) if the injury is a motor vehicle injury — on or after 1 July 2016; or

(ii) if the injury is a workplace injury — on or after 1 July 2024.

[Regulation 11 amended: SL 2024/133 r. 9.]

Division 2 — Application to participate in CISS

12. Application under s. 9 of Act

(1) In this regulation —

relevant accident means either of the following —

(a) the motor vehicle accident that resulted in the motor vehicle injury to which the application relates; or

(b) the workplace accident that resulted in the workplace injury to which the application relates.

(2) An application under section 9 of the Act must be made within 3 years after the day on which the relevant accident occurred or any longer period allowed under subregulation (3).

(3) The Commission may extend the 3 year period referred to in subregulation (2) if satisfied that there are exceptional reasons to do so.

[Regulation 12 amended: SL 2024/133 r. 10.]

13. Deferral of consideration of application

(1) The Commission may defer consideration of an application under section 9 of the Act until the Commission is satisfied that the motor vehicle injury or workplace injury to which it relates has stabilised.

(2) The Commission must give the applicant written notice of a deferral under subregulation (1).

[Regulation 13 amended: SL 2024/133 r. 11.]

14. Application under s. 13 of Act

An application under section 13 of the Act must be —

(a) made in the form approved by the Commission; and

(b) accompanied by any information specified in the form as information required to accompany the application.

15. Additional information relevant to CISS application

(1) The Commission may, by written notice, require an applicant to provide additional information the Commission considers relevant to its consideration of a CISS application.

(2) The Commission may refuse to deal with, or to continue to deal with, the CISS application until the additional information is provided.

16. Consent to obtain information

(1) The Commission may, by written notice, require an applicant to provide a consent or other authorisation the Commission considers necessary in order to obtain information relevant to its consideration of a CISS application.

(2) The Commission may refuse to deal with, or to continue to deal with, the CISS application until the consent or authorisation is provided.

17. Notice of decision on CISS application

(1) The Commission must give written notice of its decision on a CISS application to the applicant.

(2) If the decision is to refuse the CISS application, the notice must include —

(a) the reasons for the decision; and

(b) information about the dispute resolution process under Part 5 of the Act and these regulations.

18. Functional independence assessments

(1) In this regulation —

functional independence assessment means an assessment conducted using the FIMTM or WeeFIM®.

(2) When determining an injured person’s eligibility for participation in the CISS, the Commission is not required to consider a functional independence assessment in respect of the injured person unless it is conducted —

(a) by a person who, in the opinion of the Commission, is appropriately qualified to use the FIMTM or WeeFIM®, as the case requires; and

(b) within one month before the day on which the injured person’s CISS application is made or within one month after that day.

Division 3 — Interim participation

19. Period of interim participation

(1) For the purposes of section 11(1) of the Act, but subject to subregulation (2), the period for which an interim participant remains a participant in the CISS is —

(a) the period ending 2 years after the day on which the interim participant is accepted as a participant in the CISS; or

(b) if, at the end of the period referred to in paragraph (a), the Commission is not satisfied that the interim participant’s injury has stabilised, any longer period the Commission considers necessary to allow the injury to stabilise.

(2) A person’s interim participation in the CISS ends if the person is accepted as a lifetime participant.

Division 4 — Suspension of participation

20. Commission may suspend participation

The Commission may suspend the participation of a person in the CISS if —

(a) there is evidence of fraud by the person (or another person with lawful authority to act on the person’s behalf) in connection with a payment received pursuant to an agreement referred to in section 18(5) of the Act; or

(b) the person (or another person with lawful authority to act on the person’s behalf) fails to comply with a requirement under regulation 23(2); or

(d) the person fails to comply with regulation 25(2).

21. Notice of decision to suspend

(1) If the Commission decides under section 14(1) of the Act or regulation 20 to suspend the participation of a person in the CISS, the Commission must give the person written notice of its decision.

(2) The notice must include —

(a) the reasons for the decision; and

(b) information about the dispute resolution process under Part 5 of the Act and these regulations.

Part 3 — Treatment, care and support needs

22. Principles to be observed in assessment of treatment, care and support needs

(1) When assessing the treatment, care and support needs of a participant in the CISS, the Commission must take into account the principles set out in subregulation (2).

(2) The principles are as follows —

(a) any treatment, care, support or service for the participant should be necessary and reasonable to achieve the participant’s treatment, care and support goals and to maximise the participant’s capacity to undertake daily activities independently, whether in employment or in the community generally;

(b) any treatment, care, support or service for the participant should be demonstrably beneficial in terms of the participant’s treatment, care and support goals and should reasonably be expected to provide for a positive outcome for the participant that outweighs any known risks based on information from comparable cases;

(c) any treatment, care, support or service for the participant should be provided by a suitably qualified and experienced person who is appropriate to the participant’s personal circumstances and who is readily accessible to the participant;

(d) any treatment, care, support or service for the participant should represent value for money and should be delivered in a manner that ensures maximum benefits at minimum cost.

23. Requirement to provide information

(1) In this regulation —

service provider means a person who, under the CISS, provides treatment, care, support or another service to a participant in the CISS.

(2) The Commission may, by written notice, require a participant in the CISS or a service provider to provide information the Commission considers relevant to its assessment of the participant’s treatment, care and support needs.

(3) In the case of a participant in the CISS, the notice must inform the participant that failure to comply with the requirement may result in suspension of the person’s participation in the CISS under regulation 20.

(4) In the case of a service provider, the notice must inform the service provider that failure to comply with the requirement may constitute an offence.

(5) A service provider who, without reasonable excuse, fails to comply with a requirement under subregulation (2) commits an offence.

Penalty for this subregulation: a fine of $10 000.

24. Requirement to undergo examination

(1) For the purposes of determining the treatment, care and support needs of a participant in the CISS, the Commission may, by written notice, require the participant to undergo a medical examination or other examination by a health professional, or other appropriately qualified person, specified in the notice.

(2) The notice must inform the participant that failure to comply with the requirement may result in suspension of the person’s participation in the CISS under regulation 20.

25. Participant to comply with requirements in treatment, care and support assessment

(1) In this regulation —

specified means specified in the participant’s treatment, care and support assessment;

treatment, care and support requirement means a requirement for —

(a) the participant to participate in a specified activity; or

(b) the participant to receive specified treatment, care or support or another specified service.

(2) A participant in the CISS must take reasonable steps to comply with each specified treatment, care and support requirement.

Part 4 — Registered providers

26. Services to be provided by registered provider

For the purposes of section 23(1) of the Act, the following services are to be provided by a registered provider —

(a) attendant care services;

(b) case management services;

(d) dietetic services;

(e) disability employment services;

(f) domestic assistance services (for example, cleaning, gardening or home maintenance);

(g) education services;

(h) exercise services (for example, exercise physiology or personal training);

(i) home modification services;

(j) orthotic or prosthetic services;

(k) recreational services;

(l) social work services;

(m) speech pathology services;

(n) therapy assistance services;

(o) vocational training or vocational rehabilitation services;

(p) workplace training or workplace rehabilitation services.

[Regulation 26 amended: SL 2024/133 r. 12.]

27. Application for registration

An application for registration must be —

(a) made in the form approved by the Commission; and

(b) accompanied by any information specified in the form as information required to accompany the application.

28. Notice of decision on application

(1) The Commission must give written notice of its decision on an application for registration to the applicant.

(2) If the Commission decides to grant a registration, the notice must include any conditions of registration.

29. Variation, addition or cancellation of conditions of registration

(1) The Commission may, by written notice given to a registered provider, vary, add to or cancel any of the conditions of registration.

(2) Before varying or adding to the conditions of registration, the Commission must give the registered provider a reasonable opportunity to make written submissions on the proposed variation or addition.

30. Revocation of registration

(1) The Commission may, by written notice given to a registered provider, revoke its registration.

(2) Before revoking the registration, the Commission must give the registered provider a reasonable opportunity to make written submissions on the proposed revocation.

Part 5 — Dispute resolution

Division 1 — Review applications

31. Review application

(1) In this regulation —

decision, in relation to a review application, means the decision to which the review application relates.

(2) A review application must —

(a) be in writing; and

(b) include the applicant’s name, address and contact details; and

(d) give details of the injury or alleged injury to which the decision relates; and

(e) set out the reasons for disputing the decision; and

(f) be accompanied by all documents relating to the decision that are in the possession, custody or control of the applicant; and

(g) be accompanied by any medical reports or other information the applicant considers relevant to the application.

(3) A review application must be made within 28 days after the day on which notice of the decision is given or any longer period allowed under regulation 65.

32. Commission may request further information

If the Commission considers that additional information is required in connection with a review application, the Commission —

(a) may, by written notice, ask the applicant to provide the information within 28 days after the notice is given; and

(b) may defer the making of a referral under regulation 33(1), 38(1) or 46(1), as the case requires, until the information is provided or the end of the 28 day period, whichever occurs first.

Division 2 — Review of non‑medical decisions

33. Referral of decision to review officer

(1) If the Commission receives an application under section 25 of the Act in respect of a non‑medical decision, the Commission must refer the decision to a review officer for review.

(2) Subregulation (1) is subject to regulation 32(b).

(3) The Commission must give the applicant written notice of the referral and of the name of the review officer.

34. Objection to review officer

(1) The applicant may, within 14 days after notice is given under regulation 33(3) or any longer period allowed under regulation 65, object in writing to the person named in the notice being the review officer.

(2) An objection under subregulation (1) must set out the applicant’s reasons for the objection.

(3) If the applicant makes an objection under subregulation (1), the Commission may refer the decision to a different review officer.

35. Conduct of review

(1) When conducting a review, the review officer —

(a) may adopt the procedures the review officer considers appropriate; and

(b) is not bound by the rules of evidence but may inform themself in any way the review officer considers appropriate.

(2) The review officer may, by written notice, require a person to appear before the review officer at a specified time and place to answer questions or to produce material, or both.

(3) A person must not, without reasonable excuse, refuse or fail to comply with a requirement under subregulation (2).

Penalty for this subregulation: a fine of $10 000.

36. Decision on review

(1) On completion of a review, the review officer must make a decision that either —

(a) confirms or varies the non‑medical decision; or

(b) revokes the non‑medical decision and substitutes another decision.

(2) The review officer must give written notice of the decision to the applicant and to the Commission.

(3) The notice must include —

(a) the reasons for the decision; and

(b) information about the applicant’s right to appeal against the decision under section 27 of the Act.

37. Review officers

The Commission may designate a Commission officer as a review officer for the purposes of this Division.

Division 3 — Review of medical decisions

38. Referral of decision to expert review panel

(1) If the Commission receives an application under section 25 of the Act in respect of a medical decision, the Commission must refer the decision to the convenor for review by an expert review panel.

(2) Subregulation (1) is subject to regulation 32(b).

(3) The Commission must give written notice of the referral to the applicant.

(4) The convenor must convene an expert review panel to conduct the review.

39. Decision of expert review panel

(1) On completion of a review, the expert review panel must make a decision that either —

(a) confirms or varies the medical decision; or

(b) revokes the medical decision and substitutes another decision.

(2) The expert review panel must give written notice of the decision to the applicant and to the Commission.

(3) The notice must include —

(a) the reasons for the decision; and

(b) information about the applicant’s right to apply for a review of the decision under regulation 40(1).

40. Application for review of original review decision

(1) The applicant to whom an original review decision relates may apply to the Commission to have the original review decision reviewed by another expert review panel.

(2) An application under subregulation (1) must be made in writing and set out the grounds for review.

(3) The grounds for review are restricted to one or more of the following —

(a) a change in the condition of the person to whom the original review decision relates has occurred, being a change that —

(i) occurred or first became apparent after the medical decision was referred for review under regulation 38(1); and

(ii) is capable of having a material effect on the original review decision;

(b) additional information about the injury suffered by the person to whom the original review decision relates has become available, being information that —

(i) was not available, or could not reasonably have been obtained, before the medical decision was referred for review under regulation 38(1); and

(ii) is capable of having a material effect on the original review decision;

(d) the original review decision is demonstrably incorrect in a material respect.

41. Referral of original review decision to another expert review panel

(1) If the Commission receives an application under regulation 40(1), the Commission must refer the original review decision to the convenor for review by another expert review panel.

(2) The Commission must give written notice of the referral to the applicant.

(3) The convenor must convene an expert review panel (the second review panel) to conduct the review.

(4) The second review panel must consist of members who were not members of the expert review panel that made the original review decision.

42. Decision of second review panel

(1) On completion of a review, the second review panel must make a decision that either —

(a) confirms or varies the original review decision; or

(b) revokes the original review decision and substitutes another decision.

(2) The second review panel must give written notice of the decision to the applicant and to the Commission.

(3) The notice must include the reasons for the decision.

43. Effect of decision of second review panel

(1) A decision made by a second review panel under regulation 42(1) is final and binding for the purposes of the Act and cannot be reviewed or appealed against.

(2) Subregulation (1) does not affect judicial review for jurisdictional error.

44. Commission to reimburse treatment, care and support expenses in certain circumstances

(1) This regulation applies if —

(a) a medical decision the subject of a review under this Division results in a person who was an interim participant ceasing to be eligible to be a participant in the CISS; and

(b) the decision on the review revokes or has the effect of revoking the medical decision and results in the person who was an interim participant again being eligible to be a participant in the CISS.

(2) The Commission must reimburse the person for any necessary and reasonable expenses incurred by the person in relation to the person’s treatment, care and support needs in the period beginning on the day on which the medical decision was made and ending on the day on which the decision on the review was made.

Division 4 — Review of treatment, care and support assessments

45. Term used: assessment

In this Division —

assessment means a treatment, care and support assessment.

46. Referral of decision to expert review panel

(1) If the Commission receives an application under section 26 of the Act in respect of an assessment, the Commission must refer the assessment to the convenor for review by an expert review panel.

(2) Subregulation (1) is subject to regulation 32(b).

(3) The convenor must convene an expert review panel to conduct the review.

47. Decision of expert review panel

(1) On completion of a review, the expert review panel must make a decision that either —

(a) confirms or varies the assessment; or

(b) revokes the assessment and substitutes another assessment.

(2) The expert review panel must give written notice of the decision to the applicant and to the Commission.

(3) The notice must include the reasons for the decision.

48. Effect of decision of expert review panel

(1) A decision made by an expert review panel under regulation 47(1) is final and binding for the purposes of the Act and cannot be reviewed or appealed against.

(2) Subregulation (1) does not affect judicial review for jurisdictional error.

49. Commission to revise assessment

(1) If an expert review panel makes a decision under regulation 47(1) in relation to an assessment, the Commission must revise the assessment to include any changes that are needed to give effect to the decision.

(2) The Commission’s revised assessment replaces the earlier assessment.

Division 5 — Expert review panels

50. Establishment

There are to be such expert review panels as are necessary for the purposes of this Part.

51. Appointment of medical experts

(1) In this regulation —

health professional means a person registered under the Health Practitioner Regulation National Law (Western Australia) to practise a health profession (other than as a student).

(2) The Minister must appoint health professionals as medical experts for the purposes of this Part.

(3) A person appointed under subregulation (2) —

(a) is to be appointed on terms and conditions, and for a term (not exceeding 3 years), determined by the Minister; and

(b) on the expiration of a term of office, is eligible for reappointment; and

(c) is entitled to be paid any remuneration and allowances that the Minister determines on the recommendation of the Public Sector Commissioner.

(4) The office of a person appointed under subregulation (2) becomes vacant if the person —

(a) resigns by written notice addressed to the Minister; or

(b) is removed from office by the Minister for —

(i) breach of, or non‑compliance with, a condition of appointment; or

(ii) mental or physical incapacity to carry out duties of office satisfactorily; or

(iii) misconduct; or

(iv) neglect of duty; or

(v) incompetence;

(d) ceases to be registered under the Health Practitioner Regulation National Law (Western Australia); or

(e) is convicted of an indictable offence or of an offence which, if committed in this State, would be an indictable offence; or

(f) is sentenced to imprisonment for an offence.

52. Experts list

(1) The Minister must compile and maintain a list of the medical experts appointed under regulation 51(2).

(2) The Minister must ensure that the experts list is publicly available.

53. Convenor and deputy convenor

(1) From the experts list, the Minister must appoint on terms and conditions determined by the Minister —

(a) a convenor; and

(b) a deputy convenor.

(2) The deputy convenor may, subject to the direction of the convenor, exercise the functions and powers conferred on the convenor under this Division.

(3) The deputy convenor has, and may exercise, the functions and powers conferred on the convenor under this Division while the office of the convenor is vacant.

54. Constitution of expert review panel

(1) An expert review panel convened under regulation 38(4) or 41(3) must consist of 3 members selected by the convenor from the experts list.

(2) An expert review panel convened under regulation 46(3) must consist of the number of members, not exceeding 3, selected by the convenor from the experts list.

(3) If a person appointed under regulation 51(2) (the medical expert) has been engaged to treat or examine, or to furnish a report in relation to, a person (other than as a member of an expert review panel), the medical expert must not sit as a member of an expert review panel examining the person.

(4) The convenor must appoint a presiding member for each expert review panel constituted by more than one person, who is to have general responsibility for managing the operations of the panel in a particular case.

55. Convenor to give notice of members of panel

When the convenor convenes an expert review panel under regulation 38(4), 41(3) or 46(3), the convenor must give the applicant written notice of the names of the members of the panel.

56. Objection to member of panel

(1) The applicant may, within 14 days after notice is given under regulation 55 or any longer period allowed under regulation 65, object in writing to a person named in the notice being a member of the expert review panel.

(2) An objection under subregulation (1) must set out the applicant’s reasons for the objection.

(3) If the applicant makes an objection under subregulation (1), the convenor may replace the member of the expert review panel.

57. Procedures: general provisions

(1) An expert review panel is not bound by the rules of evidence but may inform itself in any way it considers appropriate.

(2) An expert review panel may act informally and without regard to technicalities and legal forms.

(3) An expert review panel may engage consultants and seek expert advice as it considers necessary in any particular case.

(4) The convenor may give directions as to the arrangement of the business of the expert review panels.

(5) The convenor may give directions as to the procedures of the expert review panels but may not give directions inconsistent with any guidelines issued by the Minister under regulation 63(1).

(6) Subject to this regulation and the other provisions of this Division, an expert review panel may determine its own procedures.

58. Acts and decisions of 2 or 3 member panel

(1) In the case of an expert review panel constituted by 2 members —

(a) an act or decision of both members of the panel constitutes an act or decision of the panel; and

(b) if the members cannot agree on a matter, another person selected by the convenor from the experts list must determine the matter as if the person constituted the expert review panel.

(2) In the case of an expert review panel constituted by 3 members, an act or decision of a majority of the members of the panel constitutes an act or decision of the panel.

59. Powers and procedures on review

(1) The applicant must give the expert review panel —

(a) a document specifying —

(i) the injury or alleged injury to which the referred decision relates; and

(ii) the facts or questions of fact relevant to the referred decision which the applicant is satisfied have been agreed and the facts or questions that are in dispute;

and

(b) copies of all documents relating to the referred decision that are in the possession, custody or control of the applicant.

(2) An expert review panel may, by written notice, require —

(a) the injured person (or a person with lawful authority to act on the injured person’s behalf) to meet with the panel and answer questions; and

(b) the injured person (or a person with lawful authority to act on the injured person’s behalf) to give to the panel copies of all documents relating to the referred decision that are in the possession, custody or control of the person; and

(3) If the injured person (or a person with lawful authority to act on the injured person’s behalf) consents, the expert review panel may, by written notice, require a person who has provided a service to the injured person in relation to the injury or alleged injury to which the referred decision relates —

(a) to meet with the panel and answer questions; and

(b) to give to the panel copies of all documents relating to the referred decision that are in the possession, custody or control of that person.

(4) Any attendance of a person before an expert review panel must be in private, unless the panel considers that it is necessary for another person to be present.

(5) A person must not, without reasonable excuse, refuse or fail to comply with a requirement under subregulation (2) or (3).

Penalty for this subregulation: a fine of $10 000.

60. Use of information in subsequent proceedings

Information given to an expert review panel cannot be used in subsequent proceedings unless —

(a) the proceedings are before a court; or

(b) the injured person, or a person with lawful authority to consent on the injured person’s behalf, consents to the use of the information.

61. Admissibility

An opinion, report, notice of determination or other document given by an expert review panel is admissible in evidence in any proceedings before a court.

62. Services and facilities

(1) The Minister must ensure that the convenor, deputy convenor and each expert review panel are provided with the services and facilities that are reasonably necessary to enable them to perform their functions.

(2) Without limiting subregulation (1), the Minister may, by arrangement with the Commission, allow the convenor, the deputy convenor or an expert review panel to make use, either full‑time or part‑time, of —

(a) the services of a Commission officer; and

(b) any services or facilities of the Commission.

63. Guidelines

(1) The Minister may issue guidelines as to the procedures of expert review panels for the purposes of —

(a) ensuring procedural fairness in those procedures; and

(b) facilitating the proper administration of those panels.

(2) The Minister must ensure that guidelines issued under subregulation (1) are publicly available.

Division 6 — Other matters

64. Costs

(1) In this regulation —

travel costs means necessary costs of travel and accommodation.

(2) The Commission must pay travel costs incurred by an applicant, or by a parent or other carer who accompanies an applicant, in order to attend proceedings relating to a review under this Part.

(3) The Commission is not liable for legal costs for or in respect of legal services provided to an applicant in relation to a review under this Part.

65. Extension of period for application or objection

The Commission may extend the period for making an application or objection under this Part if the Commission considers it appropriate to do so.

66. Correction of errors

(1) In this regulation —

reviewer means a review officer or an expert review panel.

(2) A reviewer may correct a notice of decision given by the reviewer under regulation 36(2), 39(2), 42(2) or 47(2) (the original notice of decision) if it contains a clerical or typographical error or an obvious omission or inconsistency.

(3) A reviewer may exercise the power in subregulation (2) on the application in writing of a person to whom the original notice of decision was given or on the reviewer’s own initiative.

(4) If a reviewer exercises the power in subregulation (2), the reviewer must give a replacement notice of decision to each person to whom the original notice of decision was given.

(5) A replacement notice of decision —

(a) supersedes the original notice of decision; and

(b) has effect as if given on the day on which the original notice of decision was given.

67. Period for commencing appeal

For the purposes of section 27(5) of the Act, the period is 28 days.

[Part 6 (r. 68) deleted: SL 2024/274 r. 4.]

Schedule 1 — Excluded treatment, care and support needs

[r. 5]

Terms used

In this Schedule —

participant means a participant in the CISS;

relevant injury, in relation to a participant, means the motor vehicle injury or workplace injury in respect of which the participant is a participant in the CISS;

relevant legislation means legislation of this State, the Commonwealth, another State or a Territory.

[Clause 1 amended: SL 2024/133 r. 14(1).]

Attendant care services

Attendant care services of the following kinds —

(a) services for a participant who resides overseas;

(b) services provided while a participant in the CISS is an inpatient in a hospital or undergoing inpatient rehabilitation;

(d) services provided in an unsafe environment or in circumstances that place an attendant care worker at risk of harm;

(e) services that replace parental responsibilities (for example, supervision of a young child).

Domestic assistance

Domestic assistance services of the following kinds —

(a) the provision of cleaning products or equipment;

(b) waste removal or disposal;

(d) services provided while a participant is away from the participant’s usual place of residence.

Aids and appliances

The provision of equipment of the following kinds —

(a) equipment that, under normal circumstances, is considered to be general household equipment or leisure equipment;

(b) equipment to replace equipment neglected, abused or misused by a participant;

(c) equipment that is more expensive than is required to meet a participant’s identified necessary and reasonable treatment, care and support needs.

Education support

Education support or services of the following kinds —

(a) support or services that a participant is entitled to under relevant legislation;

(b) support or services that are more appropriately funded by another person or body as part of a common or universal service obligation;

(c) support or services that a participant accessed, was assessed as needing, or was on a waiting list for, before the participant suffered the relevant injury;

(d) support involving payment of amounts charged by a school or other educational institution (for example, school or course fees, fees for excursions or school camps, stationary costs or uniform costs).

Vocational or workplace support

Vocational or workplace support or services of the following kinds —

(a) support involving capital expenditure (for example, the costs of establishing and running a business);

(b) support or services that a participant was receiving before the participant suffered the relevant injury;

(d) support to keep a business open (for example, paying for temporary staff to do a participant’s job);

(e) support involving wages subsidies for a person who employs a participant;

(f) support involving payment of ordinary expenses associated with employment or training (for example, travel costs, meal costs or uniform costs);

(g) support involving payment of the fees or other costs of a training course that a participant was enrolled in before the relevant injury.

[Clause 6 amended: SL 2024/133 r. 14(2).]

Home modifications

(1) In this clause —

belongs, community titles scheme and scheme by‑laws have the meanings given in the Community Titles Act 2018 section 3(1);

leasehold scheme, strata company and strata titles scheme have the meanings given in the Strata Titles Act 1985 section 3(1);

leasehold scheme owner has the meaning given to owner, in relation to a leasehold scheme, by the Strata Titles Act 1985 section 3(1).

(2) Modifications to a participant’s usual place of residence of the following kinds —

(a) modifications involving maintenance or repairs identified in a strata report, building report or pest inspection report;

(b) modifications that have not been permitted by the owner of the place of residence;

(i) the relevant strata company; or

(ii) if the strata titles scheme is a leasehold scheme — the leaseholder scheme owner;

(ca) if the place of residence is subject to a community titles scheme, modifications that have not been permitted by —

(i) the scheme by‑laws for the scheme; or

(ii) the scheme by‑laws for a community titles scheme to which the scheme belongs;

(d) modifications involving the construction or installation of a pool, spa or aquatic therapy facility;

(e) modifications involving the provision of ordinary household items (for example, furniture, whitegoods, fans, lights, smoke alarms or surge protectors).

[Clause 7 inserted: Gazette 31 Dec 2019 p. 4651‑2; amended: SL 2021/76 r. 4.]

Transport modifications

Modifications to a motor vehicle of the following kinds —

(a) modifications to change a manual transmission system to an automatic transmission system;

(b) modifications to more than one motor vehicle used by a participant at a particular time;

(d) modifications to a motor vehicle that is outside Australia;

(e) modifications involving repairs or replacement carried out under warranty or because of a participant’s neglect, abuse or misuse;

(f) modifications that an employer has a duty to make under relevant legislation.

Respite care

Respite care provided in an unsafe environment or in circumstances that place a participant at risk of harm.

Prostheses

The repair or replacement of prostheses because of a participant’s neglect, abuse or misuse.

[Schedule 2 deleted: SL 2024/274 r. 5.]

View image in the official source

Notes

This is a compilation of the Motor Vehicle and Workplace Accidents (Catastrophic Injuries) Regulations 2016 and includes amendments made by other written laws. For provisions that have come into operation see the compilation table.

Compilation table

Citation	Published	Commencement
Motor Vehicle (Catastrophic Injuries) Regulations 2016 1	13 May 2016 p. 1441-85	r. 1 and 2: 13 May 2016 (see r. 2(a)); Regulations other than r. 1 and 2: 14 May 2016 (see r. 2(b) and Gazette 13 May 2016 p. 1421)
Motor Vehicle (Catastrophic Injuries) Amendment Regulations 2019	31 Dec 2019 p. 4651‑2	r. 1 and 2: 31 Dec 2019 (see r. 2(a)); Regulations other than r. 1 and 2: 1 May 2020 (see r. 2(b) and SL 2020/39 cl. 2)
Motor Vehicle (Catastrophic Injuries) Amendment Regulations 2021	SL 2021/76 18 Jun 2021	r. 1 and 2: 18 Jun 2021 (see r. 2(a)); Regulations other than r. 1 and 2: 30 Jun 2021 (see r. 2(b) and SL 2021/69 cl. 2)
Treasurer Regulations Amendment (Workers Compensation) Regulations 2024 Pt. 2	SL 2024/133 26 Jun 2024	1 Jul 2024 (see r. 2(b))
Motor Vehicle and Workplace Accidents (Catastrophic Injuries) Amendment Regulations 2024	SL 2024/274 18 Dec 2024	r. 1 and 2: 18 Dec 2024 (see r. 2(a)); Regulations other than r. 1 and 2: 19 Dec 2024 (see r. 2(b))

Other notes

1 Now known as the Motor Vehicle and Workplace Accidents (Catastrophic Injuries) Regulations 2016; citation changed (see note under r. 1).

Defined terms

[This is a list of terms defined and the provisions where they are defined. The list is not part of the law.]

Defined term Provision(s)

application for registration 3

ASIA Impairment Scale 3

assessment 45

belongs Sch. 1 cl. 7(1)

CISS application 3

Commission officer 3

community titles scheme Sch. 1 cl. 7(1)

conditions of registration 3

decision 31(1)

expert review panel 3

experts list 3

FIMTM 3

functional independence assessment 18(1)

Glasgow Coma Scale 3

health professional 51(1)

injured person 3

leasehold scheme Sch. 1 cl. 7(1)

leasehold scheme owner Sch. 1 cl. 7(1)

medical decision 3

medical expert 54(3)

non-medical decision 3

original notice of decision 66(2)

original review decision 3

participant Sch. 1 cl. 1

referred decision 3

relevant accident 12(1)

relevant injury Sch. 1 cl. 1

relevant legislation Sch. 1 cl. 1

review application 3

reviewer 66(1)

review officer 3

scheme by-laws Sch. 1 cl. 7(1)

second review panel 3, 41(3)

service provider 23(1)

Snellen Scale 3

specified 25(1)

strata company Sch. 1 cl. 7(1)

strata titles scheme Sch. 1 cl. 7(1)

travel costs 64(1)

treatment, care and support requirement 25(1)

WeeFIM® 3

Westmead Post-Traumatic Amnesia Scale 3

This work is licensed under a Creative Commons Attribution 4.0 International Licence (CC BY 4.0). To view relevant information and for a link to a copy of the licence, visit www.legislation.wa.gov.au.

By Authority: GEOFF O. LAWN, Government Printer

Western Australia

Motor Vehicle and Workplace Accidents (Catastrophic Injuries) Act 2016

Motor Vehicle and Workplace Accidents (Catastrophic Injuries) Regulations 2016

Western Australia

Motor Vehicle and Workplace Accidents (Catastrophic Injuries) Regulations 2016

Contents

Part 1 — Preliminary

Citation 1
Commencement 1
Terms used 1
Assessment tools 3
Excluded treatment, care and support needs 3

Part 2 — Participation in CISS

Division 1 — Criteria for catastrophic injury

Purpose of Division 4
Spinal cord injury 4
Traumatic brain injury 4
Amputations 6
Burns 7
Permanent blindness 9

Division 2 — Application to participate in CISS

Application under s. 9 of Act 9
Deferral of consideration of application 10
Application under s. 13 of Act 10
Additional information relevant to CISS application 10
Consent to obtain information 11
Notice of decision on CISS application 11
Functional independence assessments 11

Division 3 — Interim participation

Period of interim participation 12

Division 4 — Suspension of participation

Commission may suspend participation 12
Notice of decision to suspend 13

Part 3 — Treatment, care and support needs

Principles to be observed in assessment of treatment, care and support needs 14
Requirement to provide information 15
Requirement to undergo examination 15
Participant to comply with requirements in treatment, care and support assessment 16

Eligibility and catastrophic injury: The regulations operationalise the Act’s definition of “catastrophic injury” by setting clinical and functional thresholds for five injury classes: spinal cord injury (reg 7), traumatic brain injury (reg 8), amputations (reg 9), burns (reg 10) and permanent blindness (reg 11). Each category pairs objective test criteria with effective dates: for motor‑vehicle injuries the eligibility cut‑off is 1 July 2016, and for workplace injuries it is 1 July 2024 (see regs 7(b), 8(1)(c), 9(1)(b), 10(1)(c), 11(b)). The spinal cord criteria require an ASIA Impairment Scale score of A-D (reg 7). Traumatic brain injury criteria are age‑stratified and combine post‑traumatic amnesia thresholds, imaging or coma criteria, and functional impairment on FIM/WeeFIM or the Glasgow Coma Scale, depending on age (reg 8). These are test‑anchored gates: the regulations direct which instruments count and under what timing and qualification conditions (reg 4 and reg 18).

Assessment tools and evidence windows: The regulations identify which standardised instruments are to be used (ASIA, FIM, WeeFIM, Glasgow Coma Scale, Westmead PTA Scale, Snellen Scale) and limit the Commission’s obligation to consider functional independence assessments to those done by an assessor the Commission regards as appropriately qualified and within one month either side of the application date (reg 18). This produces a narrow evidentiary window for functional assessments supporting eligibility claims.

Procedural architecture: Application mechanics are set out in Division 2. Applications under s 9 of the Act must be brought generally within three years of the accident (reg 12); the Commission may extend that period in exceptional circumstances (reg 12(3)); and the Commission may defer consideration until an injury has stabilised (reg 13). The Commission may require additional information or consent to obtain information and may suspend processing until it is provided (regs 15-16). The Commission must provide written reasons if it refuses an application and must inform applicants about dispute resolution options (reg 17).

Interim participation and suspension: Interim participants are accepted for two years as the default (reg 19), subject to extension where stabilisation is incomplete. The Commission may suspend participation on defined grounds: evidence of fraud, failure to comply with information or examination requirements, or failure to comply with specified treatment, care or support requirements (reg 20). Suspension notices must state reasons and dispute options (reg 21).

Assessment principles and obligations: When assessing treatment, care and support needs, the Commission must consider principles requiring necessity, demonstrable benefit, appropriately qualified providers who are accessible, and value for money (reg 22). Participants and service providers have statutory information‑producing obligations; service providers face a statutory fine of $10 000 for non‑compliance with information requests (reg 23(5)). The Commission can require participants to undergo medical or other examinations (reg 24), and participants must take reasonable steps to comply with specified treatment, care and support requirements (reg 25).

Registered providers: The regulations list service categories to be provided by registered providers (reg 26) and set registration mechanics: approved form, supporting information, notice of decision, conditions and rights to make submissions before conditions are varied or registration revoked (regs 27-30).

Dispute resolution and expert review: Non‑medical decisions are reviewed by a designated review officer (regs 31-37). Medical decisions and assessment disputes are referred to expert review panels convened by a Ministerially appointed convenor from an experts list; panels are composed of medical experts (regs 38-56). Expert review panels have broad fact‑finding and procedural powers, may require attendance and examinations and may obtain further expert advice (regs 57-59). There are strict time limits and objection windows for appointment and membership (regs 34, 56). Decisions of second review panels on medical issues and expert panels on assessments are final and binding within the scheme (regs 43(1) and 48(1)), subject to judicial review for jurisdictional error (regs 43(2) and 48(2)).

Excluded items and interaction with other schemes: Schedule 1 lists excluded treatment, care and support needs (e.g. services while inpatient, items covered by other legislation or entitlement, some home modifications, employer obligations, and certain education, vocational and transport supports). The Schedule deliberately cross‑references “relevant legislation” and several State Acts concerning strata and community title governance, signalling interaction with other statutory regimes for particular costs or approvals (Schedule 1 cl 1 and cl 7).

Finality, admissibility and confidentiality: Expert panel opinions and decisions are admissible in court proceedings (reg 61). Information given to panels is protected from use in subsequent proceedings unless the injured person consents or the proceedings are before a court (reg 60). The Commission must pay applicant travel costs to attend reviews but is not liable for applicants’ legal costs (reg 64).

Taken together, the regulations translate clinical definitions into administrable eligibility gates, embed a strong administrative control over evidence and process, and create a dispute architecture that privileges specialist medical panels for contested medical questions while preserving limited judicial oversight.

Primary individuals and entities affected by the regulations are set out in the text and flow from the scheme’s structure.

Participants, interim participants and applicants

Injured persons who seek participation in the CISS are directly affected. The regulations define what clinical and functional profiles qualify as catastrophic injuries (regs 7-11) and set procedural obligations on applicants (regs 12-18, 31). Applicants risk suspension of benefits for non‑compliance with information or examination requirements (regs 20, 23-25).

Service providers and registered providers

Persons or organisations providing treatment, care, support and related services to participants must engage with registration and information requirements. The regulations list the classes of services to be provided by registered providers (reg 26). Service providers can be compelled to supply information; failing to comply without reasonable excuse attracts a $10 000 fine (reg 23(5)). Registered providers face conditions of registration, and the Commission can vary conditions, revoke registration, and must give an opportunity for submissions before doing so (regs 29-30).

The Commission and Commission officers

The Insurance Commission of Western Australia (through Commission officers as defined reg 3) administers applications, deferrals, suspensions, registrations, provider conditions and reimbursements (regs 12-21, 26-30, 44, 64). The Commission also coordinates reviews and may defer making referrals pending further information (reg 32).

Minister, convenor and medical experts

The Minister appoints medical experts and must maintain a publicly available experts list (regs 51-52). The Minister also appoints a convenor and deputy convenor who manage panel business and membership (reg 53). Medical experts sit on expert review panels and are subject to terms, removal rules and disqualification in particular cases (for example, if they treated the person) (regs 51, 54(3)).

Employers and other statutory schemes

Employers may be indirectly affected because Schedule 1 excludes supports that are the employer’s statutory duty to provide (Sch 1 cl 6(c)) and excludes services that should be the subject of other statutory coverage (Sch 1 cl 5(b), cl 6(b)). Where a cost is excluded because another statutory scheme should meet it, private enterprise (employers, insurance, other public schemes) may bear that cost.

Families, carers and advocates

The regulations affect carers and relatives who may need to provide documentation, accompany applicants to reviews (travel costs are recoverable by the Commission for a parent or carer who accompanies an applicant , reg 64(2)), or act with lawful authority on behalf of applicants in hearings and consents (see regs 59(3), 60).

Legal and allied professionals

Lawyers, medical practitioners and allied health professionals supporting applications will face the evidentiary and procedural constraints the regulations impose: narrow windows for admissible functional independence assessments (reg 18), standardised test requirements (reg 4), and tight time limits for review and objection procedures (regs 31(3), 34(1), 56(1)).

Market participants providing home and vehicle modifications, prosthetics, vocational services, or education supports

The Schedule carves out excluded items and services (Schedule 1). Providers in these markets will find that particular categories of work will not be funded by the CISS , for example, vehicle transmission conversions, pools, routine household items, or training fees charged by educational institutions (Sch 1 cls 4, 7, 8, 5(d)). This shifts payment responsibilities or requires applicants to seek alternative funding sources.

Public decision‑makers and administrators

The regulations vest significant discretion in administrative actors , Commission officers, the convenor and the Minister. Those offices will undertake decisions with direct fiscal and service implications, for example suspending participation for suspected fraud (reg 20(a)), requiring examinations (reg 24), and deciding admissibility of functional assessments (reg 18).

Overall distributional effect

The scheme’s organisational design concentrates decision rights in the Commission and in expert medical panels appointed by the Minister, while putting monetary consequences and information burdens primarily on applicants and service providers. The Schedule of exclusions signals that many commonly needed items and services will be left to other schemes or private funding, moving costs away from the CISS fund to participants, employers, other government programs or private insurers.

Key duties imposed by the regulations

Duties of the Commission

To give written notice of decisions on CISS applications including reasons and dispute information (reg 17(1)-(2)).
To observe specified assessment principles when deciding treatment, care and support needs: necessity, demonstrable benefit, appropriately qualified and accessible providers, and value for money (reg 22(1)-(2)).
To provide written notice of registration decisions and set conditions (reg 28).
To provide travel costs for applicants and accompanying parent/carer for review proceedings (reg 64(2)).
To reimburse certain treatment, care and support expenses if an interim participant is wrongly excluded then later found eligible (reg 44).

Duties of applicants/participants

To apply in the form and with the information specified (reg 14, reg 27).
To provide additional information or consent to obtain information when required by written notice; the Commission may refuse to proceed until this is supplied (regs 15-16).
To undergo medical or other examinations the Commission requires to determine treatment, care and support needs (reg 24), and to take reasonable steps to comply with specified treatment, care and support requirements in an assessment (reg 25).
To meet time limits: initial application within three years of the accident unless extended for exceptional reasons (reg 12(2)-(3)), and review applications within 28 days of notice of decision unless extended (reg 31(3), reg 65).

Duties of service providers and registered providers

Registered providers must provide the services listed in reg 26 and comply with registration conditions. Service providers may be required by written notice to provide information relevant to assessment; failure to comply without reasonable excuse is an offence attracting a $10 000 fine (reg 23(2), (5)).
Registered providers are subject to variation or revocation of registration, but must be given a reasonable opportunity to make written submissions before conditions are varied or registration revoked (regs 29-30).

Duties of expert review panels and review officers

Review officers and expert panels must follow the procedural rules set out in Part 5 and give written reasons and notification of decisions (regs 35(1), 36, 39, 47). Convenor and panels must be provided with necessary services and facilities by the Minister (reg 62).

Key rights established by the regulations

Right to be notified and to reasons

Applicants have a right to written notice of Commission decisions and reasons for refusal, plus information on dispute resolution processes (reg 17(1)-(2), reg 21(1)-(2), reg 28(1)-(2)).

Right to internal review

Applicants may seek internal review of non‑medical decisions by a review officer (regs 31, 33-37).
Applicants may seek review of medical decisions by expert review panels (regs 38-43), including a second review in restricted circumstances where the grounds are limited to change in condition, new information, procedural non‑compliance, or demonstrable material error (reg 40(3)).

Right to object to reviewer or panel member

Applicants may object to the named review officer within 14 days (reg 34). Applicants can also object to a person named as a member of an expert review panel within 14 days (reg 56), and the convenor may replace a panel member on objection.

Right to have decisions enforced and revised

Where an expert review panel alters an assessment, the Commission must revise the assessment to give effect to the panel’s decision (reg 49). Where a second review panel changes a medical decision, the decision is final and binding within the scheme (reg 43).

Right to reimbursement and travel costs

The Commission must reimburse an interim participant who was excluded by a medical decision later overturned by review for necessary and reasonable treatment, care and support expenses incurred during the exclusion period (reg 44). The Commission must pay travel costs for applicants and accompanying carers for review proceedings (reg 64(2)).

Rights preserved outside the scheme

The finality clauses for internal reviews do not oust judicial review for jurisdictional error; applicants retain access to judicial review where jurisdictional error is alleged (regs 43(2), 48(2)).

Procedural safeguards

Expert panels must avoid conflict (a clinician who treated or examined the person outside the panel must not sit on that panel , reg 54(3)).
Panels are not bound by the rules of evidence (reg 57(1)), but must provide reasons and procedural fairness in accordance with Ministerial guidelines if issued (reg 63).

These duties and rights structure the behaviour of participants and providers: applicants must proactively secure evidence that fits the specified tests and consent to the Commission’s evidence‑gathering; service providers must be prepared to disclose information; the Commission has discretion to gate access and to suspend participants for non‑compliance; and medical questions are concentrated in panels whose decisions are mostly binding within the regime.

Types of enforcement mechanisms

Administrative enforcement

Suspension of participation in the CISS is an administrative remedy the Commission may use on specified grounds: fraud in connection with payments, failure to comply with information requirements, refusal to undergo required examination, or failure to comply with specified treatment, care and support requirements (reg 20). Suspension requires written notice stating reasons and dispute information (reg 21).
The Commission can defer consideration of applications until it considers the injury has stabilised (reg 13), refuse to deal with applications until additional information or consents are provided (regs 15-16), and refuse to continue processing if requirements are not met (regs 15(2), 16(2)).
For registered providers, the Commission may vary, add to or cancel conditions of registration (reg 29) and may revoke registration (reg 30). Before varying or revoking, the Commission must give the registered provider a reasonable opportunity to make written submissions (regs 29(2), 30(2)), which is an administrative procedural protection.

Monetary penalties and offences

Service providers who, without reasonable excuse, fail to comply with an information requirement under reg 23(2) commit an offence and face a fine of $10 000 (reg 23(5)).
A person must not, without reasonable excuse, refuse or fail to comply with a requirement to appear and answer questions or produce materials at a review hearing convened by a review officer (reg 35(2)-(3)) or before an expert review panel (reg 59(2)-(5)). The penalty for failing without reasonable excuse to comply with those requirements is a fine of $10 000 (reg 35(3) and reg 59(5)).
These fines are the primary criminal/penal sanctions set out in the regulations; the text does not create other monetary penalties such as civil penalties for non‑information offences.

Criminal and professional removal powers for experts

Medical experts appointed by the Minister may have their offices become vacant for specific causes including conviction for an indictable offence or an offence that would be indictable in WA, or for misconduct, neglect of duty, incompetence, or loss of registration under the Health Practitioner Regulation National Law (WA) (reg 51(4)(d)-(f)). Removal from office is a disciplinary mechanism for panel members.

Adjudicative consequences

Decisions of expert review panels and second review panels are final and binding for purposes of the Act (reg 43(1), reg 48(1)). The binding nature of these medical determinations is an enforcement mechanism in the sense that the Commission must act consistently with the panel’s decision: where an expert review panel revises an assessment, the Commission must revise its assessment to give effect to the decision (reg 49).

Monetary consequences borne by the Commission

The Commission must reimburse an interim participant for necessary and reasonable treatment, care and support expenses incurred during a period in which a medical decision wrongly excluded the person, where the review reverses that decision (reg 44). The Commission must also pay travel costs for applicants and accompanying carers to attend review proceedings (reg 64(2)). Conversely, the Commission is not liable for applicants’ legal costs in relation to reviews (reg 64(3)).

Procedural enforcement

The Commission’s power to refuse to deal further with an application until information or consent is provided (regs 15-16) functions as a strong enforcement lever that interrupts access to the scheme until statutory requirements are satisfied.

Limits and procedural safeguards

Although expert panel decisions are binding in the scheme, the regulations explicitly preserve judicial review for jurisdictional error (regs 43(2), 48(2)). Decisions that contain clerical or typographical errors may be corrected by the reviewer, and replacement notices supersede the originals (reg 66).

Practical enforcement implications

The enforcement design places more immediate financial and compliance risk on applicants and providers than on the Commission: applicants risk suspension and loss of interim benefits pending panel decisions, providers risk a $10 000 fine for failure to supply required information, and panel members risk removal for professional misconduct. The Commission, however, bears the fiscal risk of reimbursements where it has relied on a medical decision that is later overturned (reg 44).

Overall, enforcement under the regulations is a blend of administrative sanctions (deferred consideration, suspension, revocation), targeted monetary penalties for non‑cooperation ($10 000 fines for specified offences), and binding expert determinations within the internal review architecture, with limited avenues for external judicial oversight preserved.

Direct references to other statutory regimes

The regulations repeatedly reference external legislation. Commission officers are defined with reference to the Insurance Commission of Western Australia Act 1986 (reg 3). Medical experts must be registered under the Health Practitioner Regulation National Law (Western Australia) (reg 51(1)-(4)). Schedule 1 cross‑references the Community Titles Act 2018 and the Strata Titles Act 1985 in relation to home modifications and required consents (Sch 1 cl 7). These cross‑references mean that compliance with other licensing, strata/community scheme approval and employer duties under other statutes interacts materially with a participant’s eligibility for CISS funding for particular items.

Interaction with employer and other funding duties

The Schedule explicitly excludes vocational and workplace support costs that fall within an employer’s statutory duties or are otherwise appropriately funded by other bodies (Sch 1 cl 6(c), 6(b), 6(d)). Similarly, education supports that a participant is entitled to under relevant legislation are excluded (Sch 1 cl 5(a)). The regulations therefore envisage an allocation rule: the CISS is a backstop for care/treatment needs defined narrowly, not a universal payer; where other statutory obligations exist, the CISS disclaims coverage.

Evidence and court proceedings

Expert review panel opinions and reports are admissible in court (reg 61). Information provided to an expert review panel cannot be used in subsequent proceedings unless the injured person consents or the proceedings are before a court (reg 60). This statutory protection interacts with civil litigation because the regulated confidentiality of panel materials may limit their use in tort or other court proceedings unless the court is involved or the injured person has given consent.

Finality vs judicial review

The regulations create internal finality by making expert panel decisions final and binding for the purposes of the Act (regs 43 and 48). However, the regulations expressly preserve judicial review for jurisdictional error (regs 43(2), 48(2)). That creates an interface between the administrative internal review machinery and common law/due process protection through judicial review; parties dissatisfied with panel decisions can seek judicial review on jurisdictional grounds but not on merits within the scheme.

Overlap with workers’ compensation and temporal staging

The eligibility effective dates differ for motor vehicle injuries and workplace injuries: motor vehicle injuries from 1 July 2016, workplace injuries from 1 July 2024 (regs 7-11). This staged inclusion suggests an intended interplay with workers’ compensation regimes, with workplace injuries being brought into the CISS from 2024 onwards. The regulations do not define how workers’ compensation entitlements interact in specific instances, but the date cut‑offs and Schedule exclusions referring to employer duties signal an expectation of coordination or allocation between schemes.

Provisions referencing “relevant legislation”

Schedule 1 uses the term “relevant legislation” to exclude services or supports that are appropriately the responsibility of other State, Commonwealth or Territory laws (Sch 1 cl 1). That is a broad cross‑reference mechanism that requires administrators to apply other statutory entitlements as a first line before CISS funds are used.

Administrative resource sharing

The Minister may arrange for expert review panels or the convenor to make use of Commission officers or Commission facilities (reg 62). This is an internal administrative interaction, permitting shared services and indicating that the Commission’s organisational capacity and the Minister’s arrangements are intended to be integrated for panel functioning.

Net effect

Practically, the regulations leave significant interface work to administrators: determining when another statutory regime should pay, applying strata or community title approvals for home modifications, coordinating with employers or workers’ compensation, and managing confidentiality and admissibility when parallel court proceedings are contemplated. The cross‑references place a compliance and evidentiary burden on applicants to show that other entitlements are not available or appropriate before the Commission funds excluded items.

The regulations include a compilation table at the end documenting amendments and commencements. Key milestones recorded in the compilation table in the source text are:

Original instrument: Motor Vehicle (Catastrophic Injuries) Regulations 2016, published 13 May 2016 and operative (majority) 14 May 2016 (compilation table).
Motor Vehicle (Catastrophic Injuries) Amendment Regulations 2019, published 31 December 2019, with substantive provisions commencing 1 May 2020 (compilation table). The 2019 amendments included insertion of Schedule items and adjustments to home modifications (Schedule 1 cl 7) as indicated by an insertion note (see Schedule 1 cl 7 insertion note).
Motor Vehicle (Catastrophic Injuries) Amendment Regulations 2021 (SL 2021/76), published 18 June 2021 and commencing 30 June 2021 for regulations other than r 1 and 2 (compilation table). Specific amendments are referenced in the text (for example, Schedule 1 amendments noted SL 2021/76).
Treasurer Regulations Amendment (Workers Compensation) Regulations 2024 Pt. 2 (SL 2024/133), published 26 June 2024 and commencing 1 July 2024, which amended the regulations to adjust effective dates and other references in multiple provisions (multiple regs show the 2024 amendment notation). Many regs were amended by SL 2024/133 , for example, the effective date change for workplace injuries to 1 July 2024 is reflected across regs 7-11 and elsewhere (see amendment notes after those regs).
Motor Vehicle and Workplace Accidents (Catastrophic Injuries) Amendment Regulations 2024 (SL 2024/274), published 18 December 2024 and operative (substantive provisions) from 19 December 2024 (compilation table). The citation has been updated to the current title Motor Vehicle and Workplace Accidents (Catastrophic Injuries) Regulations 2016 (other notes indicate citation change).

Textual amendment markers within the body

The printed regulations include inline amendment annotations showing which provisions were altered by later instruments (e.g. “[Regulation 7 amended: SL 2024/133 r. 5]”), enabling precise tracking back to the amending statutory instrument. Several key regs (7-11, 12-13, 15, 18, 26, 29, Schedule 1 clauses) carry amendment annotations referencing SL 2024/133, SL 2021/76 and SL 2019 instruments.

Other notes and editorial history

The compilation table and “Other notes” confirm the instrument’s retitling to include workplace accidents (the current title is Motor Vehicle and Workplace Accidents (Catastrophic Injuries) Regulations 2016). The Schedule 1 insertion (cl 7) and other Schedule amendments are dated and annotated.

Practical implications of amendments

Amendments have a clear policy effect: notably, the 2024 amendments extend the effective coverage of the scheme to workplace injuries from 1 July 2024 (reflected in regs 7-11). Other amendments refine exclusions, procedural requirements and the registration/service regime (for example, addition of new service categories under reg 26 and clarification of home modification exclusions under Schedule 1 cl 7). Practitioners must therefore check the relevant amendment notes and the compilation table to ascertain which version applied to a given injury date.

Where to check for further changes

The regulations themselves state amendment footnotes and a compilation table. For live transactional work it is necessary to consult the consolidated version on the WA legislation website and the underlying amending instruments cited (SL numbers) to confirm the exact text and commencement dates.

The source document provided does not record any judicial decisions, case citations, or litigation history that interprets these regulations. There are no cases named in the regulations text, no references to prior litigation, and no annotated judicial interpretations included in the compilation notes supplied here.

What the regulations do show about litigation risk and avenues

The text preserves judicial review for jurisdictional error against decisions of expert panels (regs 43(2) and 48(2)). That is expressly retained as an avenue for challenge even though the regulations make many internal decisions final and binding within the scheme (regs 43(1), 48(1)).
Expert review panel opinions and reports are expressly admissible in court proceedings (reg 61), so materials produced under the scheme can be used in subsequent litigation if the court is involved or if the injured person consents (reg 60). This provision recognises an interface with court proceedings and means that expert panel outputs can form evidence in external litigation, subject to the confidentiality protections in reg 60.
Administrative processes and time bars are tight. Review applications must be lodged within 28 days from notice of decision unless the Commission grants an extension (reg 31(3), reg 65). Objections to panel members and objections to review officers must be made within 14 days (regs 34(1), 56(1)). Finality clauses for second review panels (reg 43(1)) reduce the scope for merits review within the scheme and thereby shape the litigation posture: appeals from scheme decisions will more commonly be brought as judicial review applications on jurisdictional grounds rather than merits appeals.

Absence of recorded precedents in this instrument

Because the regulations themselves do not contain litigation annotations, to identify any case law that interprets or challenges these regulations a practitioner must search court databases and legal reporting services for decisions referring to the Motor Vehicle and Workplace Accidents (Catastrophic Injuries) Regulations 2016 or decisions of the Commission under the Act, and check whether judicial review applications have been brought in respect of panel decisions or Commission actions. That search is outside the content of the provided document.

Strict medical and functional evidence windows and qualifications

Functional independence assessments (FIM or WeeFIM) are only required to be considered by the Commission if conducted by a person the Commission considers appropriately qualified and if the assessment was done within one month before or after the day the CISS application is made (reg 18). That narrow timing window can exclude otherwise relevant functional evidence if it is not procured at the right time or by the right assessor. Practitioners should not assume older or differently‑timed FIMs will be determinative.

Different tests and age‑specific thresholds for TBI and burns

Traumatic brain injury criteria are age‑stratified with distinct instruments and thresholds (reg 8). For adults and children 8 years and over, Westmead PTA or imaging/coma indicators plus FIM/WeeFIM impairment are required (reg 8(1)). For children 3-7, Glasgow Coma Scale or Westmead PTA plus WeeFIM deviation from age norms is required (reg 8(2)). For under 3s, a paediatric rehabilitation physician’s certificate that permanent impairment will probably occur is sufficient (reg 8(3)). Burns have similar age stratification and thickness/area criteria (reg 10). The multiplicity of pathways can create evidentiary traps if the correct instrument is not used for the applicant’s age.

Cut‑off dates differ between motor vehicle and workplace injuries

The regulations repeatedly specify that the injury must have occurred on or after 1 July 2016 for motor‑vehicle injuries and on or after 1 July 2024 for workplace injuries (eg regs 7-11). Claims arising from events before these dates will generally be out of scope. Ensure the accident date and the relevant category are identified early in advice.

Narrow scope of what is fundable , the Schedule of exclusions is extensive

Schedule 1 enumerates many normally expected items that are not funded: e.g. services while inpatient, replacement of equipment lost through neglect, ordinary household items, school fees and other education institution charges, capital expenditure for business, employer duty items, vehicle transmission conversions, multiple vehicle modifications, pools and aquatic therapy facilities, and repairs of prostheses due to misuse (Sch 1 cls 2-10). The practical effect is that a participant’s expectations must be managed: many common supports are excluded and will need alternative funding.

Commission discretion to defer and suspend

The Commission can defer consideration of an application until the injury stabilises (reg 13) and can suspend participation for reasons including non‑compliance with information or examination requests (reg 20). Interim participants are accepted for two years by default (reg 19), but interim status can be prolonged while stabilisation is awaited; this creates a period where benefits may be temporary and subject to later reversal.

Finality of expert panel decisions within the scheme

On medical matters, second review panel decisions are final and binding for purposes of the Act (reg 43(1)), and expert panel decisions on assessments are final and binding (reg 48(1)). These finality rules limit internal re-litigation of medical findings. Judicial review remains available only on jurisdictional error grounds (regs 43(2), 48(2)). Practitioners must therefore plan for limited internal avenues for re‑arguing medical findings and consider judicial review strategy early if jurisdictional grounds exist.

Obligations to consent to information gathering and the consequences of refusal

The Commission may require consent or authorisation required to obtain information (reg 16). The Commission may refuse to deal or continue to deal with an application until consent is supplied (reg 16(2)). Lack of consent can stall access to the scheme.

Penalties for refusing to attend or provide documents

A $10 000 fine applies for refusal or failure without reasonable excuse to comply with directions to attend or produce documents before review officers (reg 35(3)) or expert review panels (reg 59(5)). These are criminal fines, not civil sanctions, and can be imposed against persons summoned to assist reviews.

Registration procedural traps for providers

Registered providers must apply in the approved form and supply supporting information (reg 27), and their registration can be varied or revoked after the Commission gives them a reasonable opportunity to make submissions (regs 29-30). Registered providers should therefore maintain comprehensive documentary records and be proactive in responding to proposed condition variations.

Confidentiality limits and admissibility in court

Information given to an expert review panel is protected from use in subsequent proceedings unless the injured person consents or the proceedings are before a court (reg 60). However, panel opinions are admissible in court (reg 61). Practitioners should consider how panel materials will be used in parallel tort or indemnity litigation and obtain clear client instructions on consent.

Reimbursement is narrow and conditional

The Commission must reimburse an interim participant for expenses only if (a) a medical decision resulted in the person ceasing to be eligible and (b) the review revokes that decision so the person becomes eligible again (reg 44). The regulation confines reimbursement to necessary and reasonable expenses in the exclusion period. This is a limited remedy and does not appear to cover broader consequential losses.

Time limits and extensions

Review applications must generally be lodged within 28 days after notice of the decision (reg 31(3)). Objections to review officer or panel membership must be made within 14 days (regs 34(1), 56(1)). The Commission may extend those periods if it considers appropriate (reg 65), but extensions are discretionary and should not be relied on without evidence of good reason.

Selection of panel members and potential conflicts

The convenor selects panel members from the Minister’s experts list (reg 54). Clinicians who examined or treated a person outside the panel must not sit on the panel (reg 54(3)). Applicants can object to members within 14 days and the convenor may replace them (reg 56). However, the convenor’s discretion to appoint may create timelines or availability issues , a practical consideration in cases requiring urgent review.

Checklist and practical steps for applicants (injured persons)

Timing and application form

Lodge a CISS application within three years of the relevant accident (reg 12(2)), unless exceptional reasons can be shown for extension (reg 12(3)). Use the form approved by the Commission for applications under s 13 and ensure it is accompanied by any information specified in the form (reg 14).

Evidence strategy and assessments

Identify which clinical test and functional instrument applies to the injury class and the applicant’s age (regs 7-11, reg 4). Secure assessment evidence within the one‑month windows relative to the application date where functional independence assessments (FIM/WeeFIM) are relied on, and ensure the assessor is one the Commission would regard as appropriately qualified (reg 18). For TBIs and burns, ensure the correct instrument is used for the applicant’s age group and that imaging, Westmead PTA, Glasgow Coma Scale scores or paediatric specialist certificates are documented (reg 8, reg 10).

Consents and information

Be prepared to provide written consents or authorisations the Commission requires to obtain relevant medical or other records (reg 16). Respond promptly to any written notices requesting additional information; the Commission may refuse to deal with the application until the information or consent is provided (regs 15-16).

Anticipate deferral and interim status

Expect the Commission may defer consideration until the injury stabilises (reg 13). If accepted as an interim participant, recognise that interim participation typically lasts two years (reg 19) and that interim benefits could be reversed if a later medical decision excludes eligibility (reg 44 outlines a narrow reimbursement rule).

Prepare for reviews

If given an adverse decision, lodge a review application within 28 days of notice (reg 31(3)). Gather and submit all documents in the applicant’s possession relating to the decision, and be prepared to explain the reasons for disputing the decision (reg 31(2)(f)-(g)). For medical decisions expect referral to expert review panels; for non‑medical decisions the matter will go to a review officer (regs 33, 38).

Checklist and practical steps for service providers and potential registered providers

Registration process

If you intend to provide services listed in reg 26, apply for registration using the Commission’s approved form and supply any specified supporting information (reg 27). Expect registration to include conditions which will be notified in writing (reg 28(2)).

Information obligations and penalties

Implement systems to respond to Commission written notices requiring information. Non‑compliance without reasonable excuse is an offence punishable by a $10 000 fine (reg 23(5)). Retain records and timely responses to avoid enforcement.

Conditions and revocation risk

Be prepared to make submissions if the Commission proposes to vary conditions or revoke registration; the Commission must give a reasonable opportunity for written submissions before varying or revoking a registration (regs 29(2), 30(2)).

Service delivery and documentation

Deliver services in line with the Commission’s assessment principles: treatments must be necessary, demonstrably beneficial, delivered by suitably qualified personnel and provide value for money (reg 22). Maintain provider qualifications and availability documentation to satisfy the Commission’s accessibility and qualification tests (reg 22(2)(c)).

Steps for legal and medical advisers

Evidence collection and timing

Plan assessments to meet the one‑month functional assessment window if reliance on FIM/WeeFIM is intended (reg 18). Obtain the specific test results named in the regulations (Westmead PTA, Glasgow Coma Scale, ASIA, Snellen Scale) and ensure documentation is timely and meets the instrument standards (reg 4).

Procedural deadlines and objections

Track deadlines strictly: review applications (28 days , reg 31(3)); objections to review officers and panel members (14 days , regs 34(1), 56(1)). Apply early for extensions under reg 65 if circumstances require it.

Prepare for panel confidentiality and court use

Advise clients on the confidentiality protections for materials given to expert review panels and that those materials cannot be used in subsequent proceedings except in court or with consent (reg 60). If litigation is contemplated, seek clarity on consent for use of panel material.

Judicial review considerations

Remember that panel decisions final within the scheme can still be challenged by judicial review on jurisdictional error grounds (regs 43(2), 48(2)). If the issue raises jurisdictional questions, prepare evidence and argument accordingly.

Administrative steps for Commission officers and convenor

Maintain experts list and public availability

Ensure the Ministerially maintained experts list is current and publicly available as required (reg 52). Convenor and deputy convenor appointments must be made and their terms recorded (reg 53).

Provide clear notices and reasons

Provide written notice with reasons for refusals, suspensions and registration decisions and give information about dispute resolution channels (regs 17, 21, 28). This helps ensure procedural fairness and reduces appealable grounds.

Use the Commission’s powers judiciously

Use deferral powers (reg 13), requests for further information (reg 15), and suspension powers (reg 20) according to the statutory grounds and with clear documentation to withstand review.

Operational compliance and risk management for participants and providers

Identify alternative funding routes for any items excluded by Schedule 1. For example, if a home modification requires strata or community title approval, obtain the necessary consents before seeking CISS funding (Sch 1 cl 7). If an item is an employer obligation under relevant legislation, coordinate with the employer and workers’ compensation frameworks (Sch 1 cl 6(c)).
Keep contemporaneous evidence of communications with the Commission and copies of all documents provided to panel or review officers. This is essential where corrections of clerical errors or replacement notices might be necessary (reg 66).
Where examinations are required under reg 24 or panel summons are issued under regs 35(2) or 59(2), ensure clients attend, or document reasonable excuses for non‑attendance , non‑compliance attracts a $10 000 fine.
For interim participants, keep clear records of necessary and reasonable expenses to support any potential reimbursement claim in the narrow circumstance set out in reg 44.

In short, compliance requires early planning around evidence timing, proactive document management and consents, readiness to respond to Commission notices, registration discipline for providers, and strategic use of the internal review mechanisms with an eye to the narrow grounds and time limits that constrain re‑litigation.

Deep Dive

What it does

Current sections